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A History of Nursing 



A History of Nursing 

From the Earliest Times to the Present Day 

with Special Reference to the Work of 

the Past Thirty Years 

Edited, and in Part Written, by 

Lavinia L. Dock, r. n. 

Secretary of the International Council of Nurses, Graduate of 
Beilevue Training School, New Vork Cit/ 

In Four Volumes 
Volume IV 

With J4 Illustrations 

s - 


G. P. Putnam's Son^- 
New York and London 


Copyright, ipia 



TKc wotTc of preparing Vols. Ill and IV has been contributed for the service of 

the nursing prr)fessinii, .iiui the aTioiint ncrruing from the s.iles is to b€ utilised for 
the fund c{ the International Council of Nurses. 

Eighth Impres?ion 

Made in the United States of America 



crrAPTER r 















" J3 








Nuns i\ Clas-, 



MSTKK Agxks Karf.f 

P-undcraml Preri.knt, German Nurses" Association. 

Sister Agnes Karll to the ri^'hi . 

•Mi^s J. C. VA.N Lan'schot IIubrecht 

Prcsi.lcnt. Dutch Nurses' Association. 
Miss C. J. Tieants . . . ^ 

Lafc President, Dutch Xurses' Association. 

A.Mv TtKn.N, THi: Pionkkr of Modern Nurs- 

IN(. IN llAI.V . 

Cra(K Baxter 

' • • • 

Superintendent. Blue Cross Nurses in Naples. 

L)tJR(,TlIY SneI.L . . . _ 

Supcrinten.ient cf Nurses. Queen Helen's Training School 
in Rome. 

Pki'H ATIONERS ..... 

Mary A(.ni;s Snivi.i.y .... 

Taken when Lady Superintendent, Toronto General 



A W'aki) [n -nil. Poi.Yci.iNir irospiTAi., Rome . "-'- 





NoRAii Livingston . . . . , . i-3 

Lady Supcrinletnlcnt, Montreal GLner.d Hospital Train- 
inj; Schf«>l fur Niirsus. 

A NuRSK IN Labrador Scullinc for Sipplies iSj 

By CDurtcsy of tlu- American Journal of Xnrsing. 

Julia Rachel Avri:s ..... i''^,> 

Late Matron ■ .f All'a-d Iloipilal, Melbourne, Victoria. 

Susan B. McGaiiky 1S3 

Hun. Viec-Presiilcnt. Internatioruil Council of Nurses 
from Australia. 

A Group or Sr. Hllkn's Nurses . . . 214 
Akenkhi Hi, I . . . . . . -^5 

The first Maori Xurse fully trained and qualified to 

Nurse Akeneiii Hei ..... 215 

( In duty ui her Tent Hospital. 

GkA( K Xl.lI.L ....... 222 

First .\ssistant Inspector of Hospitals and Asylums, 
New Zealand. 

Hester Maclean 222 

Assistant Insptvtorof Hospitals and Asylums, New Zealand ; 
Editor of Kai Tiaki. 

English Hospital. Zanzibar ; Miss Rriay and 

.Miss Hkivvi rton in the Background . 22^^ 

Ca.via Hospital, Ro-MBAy .... J38 

Miss Tindall Iianding insln-rnents. 

Martha I'hi llo ...... 239 

A Brahman Nurse, Lucknow Hospital. 










By oiurti'sy of the Presl.ylLTian Rorird ui Missions. 

Miss M. E. McDonnell and Nuksks at Nkyoor 2^) 

TliK i:.MPRF:SS KOMKVO DlSTRinuriNG xMkdicines 

IN IKK Charity Hospital 


Choko Rrwf) . 

" * • • • 

Tln' first Japane;c \urse to umlertake District Nursing. 

Take IIagiwara ..... 

Red Cnji-'s Superintending Sister and Hon. V^ire-Prusident, 
International Council of Nurses. 

ClIINESI' Pliml NlRsis . 

■ • • • 

Ry courtesy of flie A nu-rican Journal of Nuning. 

Esthkr Sima.ns and her First Class op 
Corian Nurses 

• • • • 

A r,R(U P OF (\ BAN NlRSES .... 

M. El(;enik ITiubard 

• . . • . 

A leader in Cuijan Nursing. 

Isabel McIsaac ...... 

Fnrmerlv Superintendent of the Illinois Training: School 
and dun Interstate Secretary ; Head, Amiy Nurse Corps. 

French Sisti;rs of the Leper Colony of 
Manila ....... 

By courtesy of the Amirican Journal of Xursirtg. 











/^NE who found it interesting to study the calHng 
V^ of the nurse, under t]ie varied forms it took on 
in its evolution from the Middle Ages to the present 
day, would have been richly rewarded by a visit to 
Germany ai the end of the last century. There, 
side by side, in full i)anoply, with all their character- 
istic features still in the bloom of vigorous life, 
could have been found nursing orders illustrating 
each historic variation, each successive phase in re- 
ligious and economic status, as rural, fendal Germany 
changed to a modern industrial empi'-c. 

The industrial revolution, silently and irresistibly 
advancing, altered nursing comnuimtics, too, as it 
shook the foundations of home, turned wealth away 
troiu the convent, built the factory town, and cast 
thousands of women out into a new world to support 
themselves and, often, others dependent upon them, 
iis they best might. The churchlv orders that had 
been so harmoniously adapted to the social condit ions 
of a different age saw their supremacy slipping away. 

Vol. IV. — 1 I 

2 A History of Nursing 

Germany shows perfect examples of hardworking 
and cfTicient Cathohc nursiiii^' orders. They are 
practical, and follow the lead of medicrd science, but 
their numbers no longer sufficed to meet demands, 
nor did they as yet open secular schools. Then came 
the deaconess Alotherhouses, but they, too, soon 
found thai their i)atriarchal basis was too hmited - 
they could not expand indefinitely. Next were the 
first large secular schools for nurses upon the English 
pattern, Victoria House in Berlin and the Nursing 
Association of the City of Hamburg. The former 
was the creation of the Empress PVederick, who was 
a woman of advanced views.' Fraulein Louise 
Fuhrmann, the first superintendent of the house, in 
an account of it which she wrote m 1893,' said that 
the Empress had two purposes in view : one to jjrepare 
nurses for the care of the sick in their own homes, so 
that they might there have the same skilled care as 
in hospitals, and the other to open to educated young 
women an honourable and blessed vocation free from 
all the restraints of "confession." This meant simply 
that i)upils were not to be limited to one religious 
faith, but should be accepted without reference to 
tlieir creed. Though it scx'nis a matter of course 

•In iKf,9, the great scivntist Vin Idw gave a lecture l.cforo an ,,f women in Berlin, in which he declared t'-at nursing 
should l.e organised on strictly secular lines, with purely humanitar- 
ian purpose's, and urge.l the following proposals: I. Men's wards 
should he nursed by women. 2. Every large hospital should have 
a training school. 3. Small l.K-alities should have training com- 
mittees. 4. Nurses should unite in organisations. 5. Special 
institutes should provide preparatory teaching in hygiene, dietetics, 
etc. Ces. Ahhandl., off. M,,l., vol. ii., pp. 55-56. 

' Report of the Canvrcss of Hospitals and Dtspensaries, World's 
Fair, Chicago, 1893. 

The German Free Sisters 3 

now, it was revolutionary, or at least darine 
then. ^' 

The Empress laid her views before the Society 
of Domestic Hygiene, of which she was patroness, 
and the school began in a small way in 1881-82' 
without definit- rios])ital connection, but fmally, in 
1806, with Fraulein Fuhrmann, who had meantime 
been trained at the Nightingale school at St. Thomas's, 
as its head, it was attached as an indci^ndent as- 
sociation to the i)ublic hospital at Fricdrichshain, 
where the nurses were to receive their training.' 
There was a board of trustees, and a very pleasant 
and attractive home was built for the pupils. The 
training lasted for one year, but the pupils signed a 
three-year contract, and after this term were free 
cither to leave the association or to remain in its 
service throughout iheir lives. If they chose the 
latter, they were supported in sickness and old age, 
the general plan being similar to that of the religio'ias 
ordero, though the whole standard of living was more 
ample and a far greater degree of personal liberty 
allowed. At sixty, if in the service of the associa- 
tion, the nurses received pensions. (This detail has 
recently been altered. They are now insured.) 
\'ictoria House, in its day, was considered to be e.\- 
t remely advanced. 1 1 ha;; always attracted a superior 
type of women and they enjoy the advantages of a 
good position. Its pujuls. howcv.T. are badiv over- 
worked in the course of their training, owmg, no 
doubt, to the necessity of making thrifty contracts 
with the city hospitals for their services. 

The Hamburg nurses, whose home is the Erica 
House at the immense Eppendorf Tlospital, wero 

A History of Nursing - 

organised on similar lines. If ihe nurses, at the end 
ot their hospital training, sci)aratcd themselves from 
the control of the association in the management of 
which they had no share, tuey then ceased to have 
any claim on it or any right to its benefits. The 
same arrangement and the same defects continued 
in the associations of the Red Cross, which, after the 
\var of 1870, had a period of remarkable growth, and 
developed thirty or forty Motherhouses for the train- 
ing of nurses. Within one generation, these houses 
collected under their wings a staff of more than three 
thousand ^Sisters, and turned the tide in the direction 
of religious freedom, for the Red Cross necessarily 
carried on a lively competition with the religious or- 
ders for desirable probationers; religious tests were 
discarded, and a free intellectual atmosphere was 
encouraged by the dedication to large national 
service and by the stimulus of international relation- 
ships. The ideals of the Red Cross were drawn on 
heroic lines: the love of country, the service of the 
Fatherland, and ov^n beyond that, of humanity,— 
for no frontiers were known to the succour offered 
to the wounded or calamity-stricken. But the Red 
Cross Motherhouses, like the religious orders, were 
hamijercd by the necessity of supporting a large staff 
ot workers and maintaining them in their old age or 
invalidism. The nurses were, so to speak, the tools 
of charity, receiving shelter, food, clothing, pocket 
money, and provision for old age, and in return for 
this, being bound to the Motherhouse for life. In 
the struggle for existence the competition between 
nursing associations often assumed a cut-throat 
character, and many Red Cross Sisters were over- 

The German l-ree Sisters 5 

worked, undertaught, and in short, exploited The 
course ol instruction given never exceeded six 
months, and teachnig was often entireJv sacrificed 
to the exigencies of getting work done. This was not 
always the case; there are some excellent Red Cross 
hospitals, and the ser^-ice has attracted an admirable 
and talented set of women. 

Of progressive tendencies, also, in its recognition 
of the _ econon.ic situation, was tlie EvangeUsche 
Diakome Vcrein. This association owed its incep- 
tion to Professor Zimmer, who was for some- time 
Its director, and who recognised the nccessitv of 
openmg new fields of occupation to young women 
o g'ood education. Professor Zimmer held that 
the Sisters joining the society should retain as much 
mdividual freedom and independence as possible 
They, therefore, after passing through definite pre- 
paratory stages, shared in the management of the 
-society s affairs, and were expected to choose their 
own work, a radical departure from the custom of 
the older associations. It retained, however a 
strongly religious stamp, being almost as de'fin- 
nely confessional as the deaconess house The 
socK^y offered three branches of work: nursing 
teaching, and household economv. These difi-erent 
professions were taught in various selected institu- 
tions, and paths ot promotion led to the higher 
posts, and to the inner circle of VcrbandssdncesU^n to 
H-hich the Sisters might pass by election from the 
'mter circle of Vcreinsschzvcstcru. The Dmkorue 
\jrrm was at first very successful; it soon became 
scIf-supporting, and attracted a superior set of 
women. It now (iqi i) num.bers.n!-,,^ n.-.- ^1- - - -^ 

6 A History of Nursing 

members, but seems to have attained its maximum 
of growth. 

There were also nurses trained by the modem 
societies of St. John, usually women of good family 
who would not voluntarily work for a living, and were 
satisfied with a superficial training for ])hilanthropic 
work,' and cottage nurses, trained in rural districts 
or in provincial towns, who were expected to perform 
the labours of five w^omen (mother, nurse, cook, 
cleaner, and housekeeper) rn the homes of the poor, 
and whose willing ])atiencc and industry often ex- 
cited the envious admiration of philanthropists from 
countries where women were not quite so strong or 
so submissive. 

'The Rulfs f)f the Johannitcr-Ordcn say; The time of trailing 
shall be as long as the Mtjtherhouse deems neeessary for Rivinf; a 
good training, but not over six months. . . . 

Neither probationer nor Sister receives salary'. Their service is a 
voluntary labour of love f<jr suffering humanity and to the glory of 
God. After training, the Sisters (jf St. John were to return to their 
own homes and apply their knowledge for the benefit of the poor, so 
far as possible. They were to rc£pt)nd to calls from the head of the 
order when they were needed, either for war, epidemic, or some 
special emergency in the hospitals of the order. They were not to 
join other associations, except such as were allied to their order. 
The report for 1905 shows 1099 nursing Sisters, of whom 964 were 
fit for service, and. 85 were ill. Fi^r various rea.sons the rest were not 
in line of duty. Tlie hospital training was given in dc :iconess estab- 
lishments or others with which the Order of St. John afiiliated. 10.7 
per cent, of the Johannikrinncn had devoted themselves to the 
deaconess service. During the year, i ig Sisters liad been detached 
from the order, either because of chronic illness or precarious financial 
situation, or because, contrary to their promise, they had taken up 
private nursing for pay. In this case they had to refund the cost 
of their training, while in all cases of separation their badges had 
been recalled. Thirty-six had died, 296 had been devoting them- 
selves to district nursing, while 255, either through illness of their 
relatives tjr theiTiselvi'S. Iiad bci^n nii.ible so to ^'.i^rve. 


The German Free Sisters 7 

At the beginning of the new century all the signs 
indicated the coming of a change in German nursing. 
The associations whose more or less rigid forms we 
have outlined were wholly unable to meet the de- 
mands of an adequate public hospital service, and 
yet a steady exodus of nurses from their gates was 
going on, and hundreds of women, driven chiefly by 
the need of earning a more ample living, but partly 
also by revolt against an arbitrarily narrowed exist- 
ence and starved personality, were leaving the 
deaconess orders, the Red Cross service, and the 
nursing associations, and, lonely and isolated, atoms 
tossed about in the labour market, were tr\-ing to 
support themselves at private duty or in positions. 
They were called the "Free" or the "Wild" Sisters. 
In reality these were pioneers in the revolt against 
the unpaid labour of women. They had been toiling 
fc: a mere subsistence. So much did the Mother- 
houses regard tliis as the order of nature, that they 
could not dream of altering it, nor would they have 
known how to do so. The problem, facing the free 
Sisters was to obtain a living wage in competition 
with Motherhouses partly supported by charity or 
endowments, wjiich had set the price for nursing 
service at a minimum impossible for those who were 
self-dependent workers. Behind and over the eco- 
noTTiic situation v.-as the power of the Church, here- 
tofore the chief employer of women. A foreign 
nurse, observing these things sympathetically in 
1899, wrote of the free Sisters: "Their lives are 
rather forlorn. The doctors and patients do not like 
them as well as the deaconesses (or pretend they do 

not ). thc^' nrr> mo'^tTT-^lir ^^:,i 1 I .. . i j 


A Histoiy of Nursing 

to strengthen one another. One longs to help them, 
but does not know how. Their help must come from 
themselves and will be the result of a long, slow 
process." She described the various forms of or- 
ganisation and added: "The last stage of develop, 
ment, that into self-governing associations, has not 
yet come." 

A lea. Ilt was needed. Who was it to be? There 
were women of commanding personality, great execu- 
tive talent, character, and force, who we e then con- 
spicuous in the German nursing world, but they 
had not large vision. Their interests were provincial. 
The looked-for leader, however, had even then been 
storing heart and mind with evidence of the friend- 
less, helpless state of nurses, and when the opportune 
moment came, she was ready, a woman more forceful 
and able than those already prominent, of executive 
ability superior, and with a sympathy and compre- 
hension that excluded none. 

_ In 1902, a Germau magazine devoted to nursin^ 
interests contained an article by Sister Agnes Kadf 
giving the history . f the formation of a modern' 
independent union of nurses, ' in which she .aid : 

The need of an organisation for the hun.lrcds of nurses 
who had withdrawn from the existing orders has been 
widely realised in the last few years. At the meeting of 
the National Council of Women, it was first openly 
urged by the widow of Professor Krr.kcnhcrg, Bonn and 
agreed to by the two hundred and thirty representatives 
of eighty thousand German women, that nursing should 

'Die Brruf.sor,, animation der Krankenpflc<^erin,ren Deutschlands: in 
Uu Krankenpfl^gc, vol. ii., part 5, i9o;:-3, p. 461. 


- ,1 

I'-in>.|,r ami Pr.-si.l,-iil. (•..rnKiM N„r^. s' As,,,, ,,.i„,„ 


'\ The Free Sisters 9 

be looked upon as a skilled pursuit for women who 
desired industrial freedom, in contradistinction to the 
conservative view that it must cither be monopolised 
by religious or charitable bodies or be left to ignorant 

Agnes Karl! defended energetically the new order 
of free nurses, and said: 

Undeveloped and timid women will do better to re- 
main in. the de.aconess or Red Cross orders, where they 
never have to think for themselves, but it is useless to 
bhiid one's self to the rapidly changing conditions of 
to-day; . . . numberless women who are eager to devote 
themselves to some kind of service to their fellow men 
find the limitations of the deaconess and Red Cross 
sisterhoods too narrow. . . . Above all thmgs we 
wish in our organisation to jireserve personal freedom and 
self-government on a rational basis. 

In this article she made clear the nurses' wish for 
three years of training. When the quinquennial 
meeting of tlie International Council of Women, to 
which the British and American nurses were then 
affiliated, took place in Berlin, in the summer oi 
1904, English, Irish, and American assembled 
in that city and there for the first time met Sister 
Agnes Karll, who had been working out her ])robIems 
unaided. Until the winter of 1903, she had not even 
known of the nursing aflairs of England or .\mcrica, 
nor liad she been aware that the German movement 
was ahead" being sympathetically watched in those 
countries. To Hnd that fellow-workers of other lands 
were ready and waiting to draw her into an inter- 
national circle whose members all, with interests and 



A History of Nursing 

aims alike, strengthened one another by moral sup- 
port, sympathy, and encouragement, was a great joy 
and a most unexpected source of help to her The 
visitors, in their turn, were impressed and stirred 
by the whole-heartedness w ith whirh she !iad dedi- 
cated all her jjowers to the upbuilding undertaken as 
her life-work. Trained in one of the best Red Cross 
hospitals, with an inheritance that made leadership 
natural, possessed of a far-seeing intellect and keen 
judgment, and with a real ;);';sion for bringing help 
to the individual, Sister i^gnes lived modestly on a 
small private income and dev cd time, strength, and 
brains freely to the service ol nurses. 

What she has done so far shall be told in her own 
words : 

The opening of the new century was a turning-point 
in our profession. Numerous occurrences of a painful 
nature, I regret to say, had brought it sharj)!)- home to 
the general {lublic that a comi)lcte transition fn^m the 
older charitable and religious systems of sitk-nursing, to a 
new and secular fomi. had take a place unnoticed. In 
the course of this silent transition, abuses had been 
permitted to develop which, if not checked, would soon 
drag the noblest and most womanly of all occupations 
in the mire, and yet the new form was the only one which 
could possibly promise to fill the great deficit in the 
numbers of nurses. Two events of the summer of 1901 
had caused especial consternation. One was an actual 
strike declared by nurses:— "Nursing Sisters on Strike." 
said the headlines in the papers; and these, moreover, 
were not the "wild nurses" at all. but deaconesses and 
Sisters of St. John. The daily papers teemed with the 
news, but presently the powerful association of deacon- 
ess Mothcrhouses found a way to stop tlic publicity of 

The German Free Sisters 


details m which the despotism of Matrons had plavcd an 
unlovely part. The other incident was a conllict between 
me<hcal nu.n, when, ihv ^•ict.Jry bein^^ to the strone. the 
bisters, havm^r b^en arrayed on the weaker side' were 
driven off the field. 

At the moment when the feelinK aroused by thc-,e 
events was running hi^h, there appeared a pamphlet by 
Sister T- l,,abeth Storp, called The Social Status of the 
^unc, uhich e.xcited keen interest. The numerous ar- 
ticles m the daily press had naturally been characterised 
by complete lack of knowled^-e of the theme under dis- 
cussion. Much had been written of the motives with 
winch nurses took up their work, but little of the actual 
conditions of their lives, an,l still less of remedies for 
the great hardships tluy endured. It was, th.Tcfore 
most timely for one of our own number ^o come forward 
to point out the real difiiculties with which nurses had 
to struggle m their calling, such as extreme overwork 
insufficient j.ay, and an entire ab.sence of all security 
fur the future when old age or ill-health should overtake 
them. It was well, to(;, for the declaration now t,, be 
made that these hardships could only be abale<l by 
state regulation of training; the general emplovment 
ot trained nurses in institutions an<l iu the municipal 
service; the creation of a free employment bureau for 
them; the establishment of recreation and convalescent 
homes, and above all. the elevation of the status of the 
nurse and her attainme-t of a higher standard of living - 
Frau Mane Stritt, then president of the National Council 
ot Uonun of Germany, brought this i.amphlet to the 
notice of Augusta Schmidt, of the Alliicmcinc Deutsche 
trauen-VeretnAhv veteran of the Woman Movement in 
Germany, when she came, in the early autumn, to the 
K^erai annual meeting of i<).„. and it was then deci.led 
that the subject of nursing and the state of the nursing 
body should be taken up for consideration at the next 




A History of Nursinij 

year's Cuuncil. To Frau Professor Krukenberg, as the 
widow of a i)liysician, was assi<,mcJ the rcsj^onsibility of 
the preliminary work of inquiry into the subject, for the 
dense ij,'noranee of all those present as to the conditions 
of nursing was clearly evident in the discussions. 

Public attention was still furlher stirred toward the 
end of U)Oi and the beginning of 1902, by the publication 
of a pamphlet bringing scandalous accusations against 
the Hamburg hospital, and in the resultant lawsuit un- 
savoury details were aired in\-olving t'le j)n\'at.e nursing 
institutions. Nurses, however, though the ones most 
concerned, took the smallest share in the general dis- 
cussions and showed the least interest, owing, obviously, 
to the shut-in character of their lives and their incessant 
strain under exh , ing work. However, in 1902, they 
were stimulated 3test against oppressive conditions 

at the time when the act for the legal i)rotecti(jn of the 
Red Cross insignia took elTecl. Ron-ly as tliis act was 
needed to jnjt a stop to the grovv'ing misuse by commercial 
establishments f)f the Red Cross symbol, it yet caused 
real distress to many of the best nurses in independent 
private practice, who liad worn the l)adge in good faith 
for years, believing that they were entitled to it because of 
their training in Red Cross hospitals, their honourable 
reasons for leaving the ^b)therhouse (often thc' necessity 
of supi)orting nlalivis), and their standing contract to 
serve in time of war. 

A little group of nurses who had come into relation 
with one another through vSister Storp's patnplilet, met 
one day in Merlin to talk over all these things. There were 
Rist'T Elizabeth Storp, vSistcr Hel^ne Meyer. Sister Marie 
Caucr, who had writt'-n much and admirably in profes- 
sional journals on thc conditions of nursing, and I. We 
discussed with great earnestness thc coming meeting of 
the Council of Women in October, in Wiesbaden, the at- 
titude they would take in nursing matters, and tli.' de- 

The German Free Sisters 13 

rnands they contemplated making upon the government 
fur nursmg reforms, details in all of which we ha^ been 
asked to give our cour^^el. The women's suggestions for 
legislation seemed to us not quite desirable, and to me 
especially, with my ten year's experience of private duty' 
their ultras of state control of private nurses seemed im- 
practicable. My colleagues, whose lives had been spent 
m hospital work, laid the chief emphasis upon hospital 
re orm. and one and all planned to go to Wiesbaden to 
take part in the proceedings. 

I nlone was not satisfied, for the prospect of future 
rvtorms ui ho.j)u,Is gave no promise of help for the 
hundreds of nurses who were now and had been for years 
makmg the hard struggle for existence in the lonelv 
Isolation of private duty. It was clear to me that thev 
n-.ust umte; clear, too, that this union must be outside o'f 
he hospitals; yet t , form independent associations was a 
thing unheard of for German nurses. While I hesitated 
tne correspondence over the proposed resolutions went 
on, and at last Frau Krukenberg wrote.— " The onlv prac- 
tical remedy for all abuses is self-organisation."' This 
dc'daratum made me also decide to go to Wiesbaden 

I had long hung all my hopes for improvement in nurs- 
ing conditions on the Woman Movement. Like a'] nurses 
•n pnvate practice, I had had little time to f„rm new r.- 
la ion^.nps. but through friends I had been kept supplied 
wuh tin. iu.naure nf the movement, and during my ten 
years of pnvate duty, and bc^fore that in several years of 
vaned experience witii hospital w..rk, I I,a,l gi^en my 
>1'are time to a thorough study of all that the Woman 
Movement implied and inclu.led. Then a fortunate acei- 
" "t . or let us say a dispensation, had put n.e in the way 
■ . d.scovcnng the only road then leading o a provision 
f..r the future of our nursc^: namely, the annuity and in- 
a idity pension arrangement of the German Anchor Life 
Insurance Society. \VU,n my long overtaxed strength 


A History of Nursing 

finally failed so far as to compel me, in 1901 to give up 
nursmg. I had devoted myself to a careful study of the 
possibilities of private -md government insurance, gaining 
aJso, m the course of this i-quiry, a personal knowledge of 
the nurses' homes in Berlin. Thes.. homes, while rapidly 
increasing in numbers, were fast acquiring a very unde- 
sirable rcputatifm. and it was the experiences of this 
year that gave me courage and perseverance to take the 
helm when the time came. 

The meeting took place. It was a glorious autumn 
day as we entered Wiesbaden. How I v^^^h that 
every Sister might have been there witli us for just 
that one session, when, for the first time, a vast throng 
of women, the representatives of 80,000 members of 
the federated women's societies, took up the conditions 
o. the nursing profession for discussion! Hitherto the 
public and the press had held it to be a desecration 
to practice nursing as a means of livelihood. Here, on 
the contrary, it was regarded as self-evident that this 
was one of the most natural of self-supporting occupa- 
tions for women, and that, without nee.l of a reli-nous 
background, it might be built up on solid founda- 
tions with thorough training aid sensible conditions of 
living. Augusta Schmidt was dead, hut niany other 
veterans of the Woman's Movement greeted us with the 
warmest kindliness, and I felt certain that this was the 
only direction in which we might look for energetic help: 
equally certain that we must unite among our.sdvcs at the 
earliest possible moment. Fraulrin v<hi Wallmenich 
from the Rc'd Cross hospital in Munich, was on the 
programme, and. naturally, took the position—" Nursin- 
uncontrolle. 1 by Motherhouses, is impossible. " Motions 
were made by Frau Krukcnberg and Fr.u Eichholz, and 
were supported, but were finally withdrawn in favour of 
one framed by our group, in some parts of which wc had 
had the collaboration of Professor Zimmcr. 

The German Free Sisters i ;: 

It was as follows:-" The Council oi Women shall 
present a memorial to the proper officers of the govern- 
nient. contamm- a petition covenn.s; the following; points- 
it -ihouhi be the duty of the State:— 

•• ( I J To defme a three years' training for nurses that 
shall be recognised by the state; to admit nurses having 
passed through such a course to a state examination 
and to oestow upon all successful applicants a state 
certiacate and a legally protected badge which may be 
removed by the proper authorities for sufficient cause. 
(2) Only those hospitals shall be recognised as can 
show a proper care for their nurses through the limitation 
of working hours to eleven daily, and through a sufficient 
provision for their stall in old age and invalidity, the 
state to set an example of a model nursing orgam'sation 
UMch sliall g,ve <lue balance to the administrative 
tnalical and nursing spheres, and secure the moral and 
material interests of the nursing staif " 

After Fraulein von Wallmenich, Sister Marie Caiier 
nii'i Professor Zimmer spoke, and the resolution was tlun 
unanimously adopted u-ithout amendment. To-dav a 
nnail part ot our demand has been realised, and we need 
not despair of gaining the rest in the course of time if we 
o" onr duty. 

-Many precious relation.ships are woven in with those 
^lays in Wiesbaden, and many good were gained 
t'jr our cause: I need only menticm Frau Poensgen, Frnu 
Krukenbcrg, Frau Cauer. an<l Oberst Galli 

Only Berlin would do, of course, as the centre of our 
'^<"v organisation, for besides being tlu- seat of ..n-ern- 
•n>'nt It was the home of by far the largest number of 

mirscs. Immediately upon my return I began taking 
H'ps to carry out .,ur plans. It seemed to mc impossible 

■ ■ ".n. ertake such a responsible business venture without 
"' advice of men. and so I tried to secure Herr Oeh 

^an.tats Rath Aschenborn and Herr Oberst CVnlli a^ 


A History of Nursing 

president and treasurer. Already warmly interested 
in our cause throuKh Sister Helene Meyer, Ilerr Gch. 
Rath Aschenborn heljK'd me willingly to frame the by- 
laws which, with a few additions, are in force to-day, but 
he advised me emphatically to have no one but nurses 
upon the Kovernin- board; for, he said, "The members 
of a profession are the only ones who can judKC correctly 
in the affairs of their profession." And Oberst Galli, 
on grounds of health, could otler us no li.xed services, but 
Kave us the first hundred marks for our trea.sury. We 
soon succeeded in findinj,^ the women needed as organising 
members for the new society. Sister Clara Weidemann, 
Sister Anna Wundsch, I- rau Dr. Metzger, and Fraulein 
Heydel promised to hdy, me, and on Januarv 1 1, 1903, wc 
called a meeting in the Emmaus Sisters' Home to found 
the German Nurses' Association. To our delight and 
surprise thirty-seven Sisters, all of whom showed intense 
and ready interest, answere>; the call. Yet doubts as to 
the possibility of success were inevitable, and another 
meeting was propo.sed. I . objected— " Now or never'" 
and carried the day. The by-laws were read a second 
tmie and adopted by twenty-eight of those present. 
The next day two inore nurses entered, so that we had a 
membership list of thirty to take to the chief of police 
with our announcement. 

To send the necessary notification of our organisation 
to the proper department of the government was our 
first public step. To-day - ne of our many members 
dreams of the trembling fear, the anxious deliberation, 
witri which we few women ventured into this, to us, so 
absolutely unkn< .wn a region. Limited means, no asr'ist- 
ants, no experience. The b--laws had to be sent in 
duplicate with the notification. Who wrote the clearest 
hand? Sister Fanny Kraft met this demand successfully. 
Next came the notification to the Amts^ericht, the 
local bureau. The first attemi)t was vain. All five 

The German Free Sisters 



members of the executive committee and officers of the 
dissociation must appear b.-fore the court at a certain 
hot.r m the morning. After a thorou-h scrutiny of our 
by-laws, It appeared that we could not obtain a simple 
association charter, as in our contemplated office and 
re-istry we were rc-arded as conducting a business. We 
were advised to seek a corporation charter, and this was 
even more satisfactory to us, as it f,^ave us more important 
standm-. That it took lon-^-cr did not mattcT, but it did 
much matter that we should be released from the neces- 
sity of having all the officers appear at a particular time 
and j.laee m the huge city, every time there was a change 
of uthcers or an amendment to the by-laws. This dela'il 
hard enough for business men to meet, would have been 
simply impossiiile for us. 

Our first !,ow in public having been thus successfully 
ma<.c, we hastened to increase our membership The 
friendly precincts of "Emmaus" still, as at fir.t .^•^ve us 
a meeting place. The presidency was cntrusle.Ao mc- 
I-rauiLin undertook the secretarvsliip and vice- 
prcsideney, for none of us had .-ver kept minutes, far less 
cnn.luct.d a meeting. Sister Clara Weidemam,, Frau 
Metzger. and Sister Anna Wundsch filled the rest of the 
cfTices. No one had time to va,rk outside of the hours 
of meetings. All that T ,-o„M not ,]o mv.self I must find 
volunteer help for. A temporary office with registrv was 
';' '''I"!"''! m the tiny flat where I live<l with four nurses 
^. t.r .Mane Stai; vn, whose health did not permit any 
longer <;f private dutj-, and who kept house for us. was 
^'Hvays ready .0 he!,.. Several Sisters oflcre.l to help 
ulKn off duty. Then there was a lively coming and 
.'"ing, telephoning and general activitv. Writing could 
' • y '-e done after ten o'clock at niKht. A group of 
' 'TSL's in other places had already become linkc^l with 
' 'ir httlc home through the years of past work 
V -.s the mieletis for our employment agc.ry. Lists of 



A History of Nursing 

addresses were put up, invitations sent broadcast to 
interested friends, hecto.i^Taphinj,', enveloi)ing, addressing, 
stamping was to be done 1 )y t he hundred, llie work "vas 
arduous, but what delight we took in this first co-opera- 
tive work for a great end ! 

On January ^(jih we held our first pubHc meeting in 
the assembly room of the Girls' High School in Burg- 
grafen Street. It was most kindly placed at our disposal 
by the Princijxil, and we only had to rent the chairs. Our 
audience had been invited by cards and notices in the 
daily pai)ers. The j)resident of a woman teachers' 
association remarked after this meeting that "one could 
easily distinguish the Sisters from the rest of the audience 
by their expressions. A veil of weariness seemed to 
cloud their faces. One could sec that they had no time 
to adjust their minds to new ideas." I cannot describe 
the embarrassment with which I began my first ]3ublic 
address on nursing conditions and our aspirations. Only 
two doctors came— Professor Salzwedel and Dr. Jacob- 
sohn. The fc^rmer was instructor at Charite, where 
a three months' course in nursing was conducted. At 
that time, it was the only public course under govern- 
mental auspices fur training in nursing. Jt was open to 
e\-eryone, men and women alike, upon i)ayment of a 
moderate fee, and was terminated by a stair examination 
Dr. Jacobsohn was the editor of the Deutsche Kmnkcn- 
pfle'^e ZeitiiH'^. In the discussion he, supported by Pro- 
fessor Salzwedel, took the position that if we regarded 
our calling as a profession, we should give up the title of 
Sister, as to retain it was only going half-way. Though 
none of us agreed with him, we were not jircpared to 
refute his argument, but Friiulein Hcydel deftly came to 
the rescue, declaring that the professional nurse was now 
forming a sisterhood, and would do wisely in retaining 
this name, so intimately interwoven with the life of the 
people. The president ihcn ImI,] .jmnli.-i-is nn th- i^.-.inf. 

The German Free Sisters 


th:U (jnly through sisterly union could our aims be 
n-ached. Thus the professional idea and that of sister- 
hood ivere united in the outset of our career, even if 
not as firmly as they must be in the future. 

This meeting brought us many new members, as did 
also our next on February 28th in the Victoria Ly- 
eMim. when I-rau Krukenberg spoke on "Professional 
Organisation for Nurses." Work also increased, as 
testimonials and endorsements had to be verified and 
Sister Eugenia von RaussendoriT offered her services 
Now also eame the first one of the many official journeys 
of the president, and the membership list grew so fast 
that It was no longer possible to carry on the registry 
work m our little dwelling, where nurses on private cases 
for night duty often came home to sleep. So after 
careful deliberation we made the plunge and rented the 
first office m the garden house at Bayreuther Street 
iMster Eugcma having promised to rent two of the rooms 
and to act as registrar. It was a serious question to be 
responsible for the rent, the telephone, salaries, and 
furnishings. Many were tne knotty points to be decided 
Our by-laws with a letter were sent to all the 2400 physi- 
nansm Berlin, and Sister Kathe Angermeyer and Sister 
1:. fnde Beltenstaedt helped with the ever greater task of 
addressing and mailing. Such an extraordinary amount 
"f mail matter fdl into the division post-office that they 
i-«.ked darkly at us there, and we divided our mail be- 
tween several districts. 

In March, at the annual meeting a sort of court of 
appeals was chosen, and two Sisters who had taken 
business training were appointed as auditors. Manvr 
other things were dealt with at that meeting. It was 
iiioved to attempt some approach to the Red Cross 
^'ociety, and we applied to them for the use of their for our badge; then there was the eligibility 

for wnr scrviei' 

espcciuii_\ uuii a view to 


A History of Nursing 

the claim for pcst-Kradualc courses in hospitals, wliich 
we wished to press cner-elieal!y, knowin- well how 
many ^aps tliere were in our trainin^^; the question of 
reduced railroad rates for the Sisters and the Krantin.' 
of a charter had also to he considered, countless visits 
made, and preparatory work done for all tluse various 
memorials. What we would have done without our 
most loyal of all friends. Herr Rittmeister Praetorius and 
his wiR. :t js impossible to ima^nne. He, as member of 
the Reichstag an,l the Prussian Diet, could always advise 
drill us unsoiJhistieatcd Sisters in the forms, ceremonies 
and proper use of titles in addressing the various off.ciai 
bodies, and show us how to go about managing our affairs 
But all <,ur memorials were at first fruitless, with the 
excei)tion ol the reduced railroad rates. In 1903 after a 
searching and favourable scrutiny of our nurscs"''district 
'.vork with the poor, this, to our great satisfaction, was 

The correspondence had now assumed such dimensions 

that a second Sister was installed in the office in Au-ust 

luox -^all we e-or again feel such " .cination\nd 

exhilaration as in those early days? Shan we ever greet 

even the greatest success, attained with difficulty as all 

must be, with such rejoicing as we felt then o\'er t'he 

smallest steps forward.? In that little circle it was 

possible to come into close contact with each- the c'r 

rcspondence with the distant Sisters could be persom'h' ' 

and intimately carried on; one could share the needs and 

the cares, great and small, of each one in a way that now 

with the many hundreds, is impossible, greatly as one 

longs to do It, for the day has only so manv hours and 

strength has its limitations; and that some feel grieved 

when they return, remembering the old times, now to 

hud new faces and a great pressure of business absorbing' 

every one, we who went through the first days tmder"^ 

stand very well. But patience! The individnnl ,viii 

The German l-rcc Sisters 


i2:;:::z;x:^'' -^ '-- »- '°- « ^^ 

its head u>,o „i,.„,ed """•■; ™'-" "■"" " "-•- "' 
'"•""'". In r. Iv , , "™- '^rtcd sister to every 

.....ier the .i'dir^hip' I,™: ^s ;;;;:;•'«'-"' -™.' 

It was a private institution of F a k " t "sl' 'T^;' "" 
llniven lliat in Marel, ,„„« '""'''""'■ So well has t 

headquarters. Nex the f' t , T™ "' °""""'' "^"'- 

sympathy with US It "'"•'"*■"■ "•"= in 

fairificetodevelonsueh'. '-,";™"S much personal 

al that thevh, "-■'■'"" """"be wondered 

-n,e one whi J« 4™! h 'f """ '"«""'"• ">™ 
-;«.« annulate wader r^;:^:;Z:r:l^^ 

.'1 *e e: u:?t;a:is:r:; tv ";'■ -■-""■■"« ttd 

nurses bv the nece," tv ^7l- '''^ ''"'"^d ^fietly to 

".-; i-l •'■le hands T^ , '■'""'•' ""= K™""! raanaRe- 

^.endesirons'^f,..*,tW '"'""'•''''■ ■^''"•■' ' '-•-= 
'■-~e int<Tested i,r ™-oPeratmn of women who 

>P-ationo/U;i ;^ajr "' -*■■"' ""^'"^ "- 

' ■ "fficers, provided "Co eo'Tthlrr" '^°"* 

' ' ^0 intclli.^cnllv xvhh . ^ .' , ,''°"^-"'^- ^hat they sympa- 

'--'^^'i must ever preveM n^^r^ r^r °"' ^' ^^'"''" ^"^ 


' ■■ 'I' out of <.ur luu.ds because itV °"' '"'^''^ 

' I'onsibility. ^ '" '^^^'^^ "ot to take 

J!^J:..''''J}''^' ^^""^ ^^ independence w^^l..,,. 

'^ 'J'ust never forj,a.t th 

1-^; and evi 



A History of Nursing- 

member must realise her duty of responsibility to our 
own association, which we ourselves have called into 
being. Only the harmonious working of all parts in 
unity can ensure its fullest usefulness for the benefit of all 
its memLors. Again, though every organisation has the 
right and even the duty of refusing the membership of 
the unworthy or the un lesirable, yet its aim should not 
be to limit itself solely to a small select circle, but to 
include the greatest possible number of the average 
people, giving them that sui)port which they, even more 
than others, need, not only in business and in professional 
interests, but still more in hum-an brotherhood. 

In every other profession than ours a standard of 
efficiency has been developed, whilst in nursing, so long 
as this was monopolised by religious and charitable 
bodies, the importance of professional knowledge was 
often quite overlooked and religious motives and luties 
were given front place, naturally resulting in collisions 
with the claims of science and hygiene. As necessity, 
during the last few decades, gradually im[)rintcd upon 
nursing the stamp of a self-supporting occui)ation for 
women, it was inevitable that in the absence of an 
acce{ited professional standard imijroprieties of the most 
deplorab!;- kind should occur, such as the incidents which 
first called our association into being and, next, compelled 
the government to take precautionary measures. 

Above all must we strive for this— that with the im- 
proved technical education wo shall iK-ver, in time to 
come, lose that which is most needful in our calling and 
which can only be imperfectly defined by law, namely, 
an enriched ethical ideal. This we need overywhere, but urgenily upon the battlefield of the social misery 
of our times. This gives the tnnnpet-call to all noble 
natures, men or women, anione <iur jn'ople. ind uc. who 
by virtu.' of our railing should be first to respond, are the 
most poorly anned for tlu- fight, because, in our hospitals 

The German Free Sisters 


wc have been drilled simply iu llic icchnical side of 
nursing without l)eing given sufficient comprehension of 
the claiiiis uf humanit3\ This is the reason why, for 
such positions as that of Sister in the women's venerer'l 
wards of a large city hospital, one seeks almost in vain 
ior suitably prepared women who arc ready to assume the 
most difficult, yet most sacred tasks of our calling. !• or 
tlHTc it is not only a question of caring iuT the body, but 
(if finding the lost soul; there it is a question of taking 
the sins of the whole world upon our shoulders; such 
wijvk calls not only for special qualities, but also special 
training and pre[)aration, as not everyone can be an 
(•riginal genius and succeed in creating professional 

Only the hospitals can lay the foundations for our 
calling. It was tliercfore naturally of the greatest 
importance that we should cultivate relations with them. 
The increasing shortage in the numbers of nurses was 
the usual starting-point of negotiations between us, which 
were often broken ofl by mistrust of our form of organisa- 
tion. The City hospital in Frankfort- a- M. took our 
probationers willingly from 1904 until 1907, when it 
suddenly forbade its accepted pupils to remain members 
of our society. Tlioir reasons for this step are hardly 
clear, for no hospital needs to fear our self-government, 
or to suspect that wc shall remove probationers or Sisters 
from its service, a thing wc would not do even if we could. 
We are at all times the best champions of the hospitals, 
a=; their interests are identical with ourr. We difl oppose 
the custom of binding i)robatinners by a money dei)osit, 
for this custom is either useless or hamiful. However, in 
the matter of the two- or three-years' contract, we agree 
vith the hospitals only if thev extend their plain duty of 
liM( liing over the entire time of the nurses' service. 
This would be, moreover, the best solution of one of the 
kjreatest diflicultics, namelv, the overburdening of both 


A History of Nursin^f 

hospital antl jjupil in ihe attempt to give t. 
training in one year's time. " 


The rapid growth and pressing activities of the 
young society soon brought the need of a professional 
organ to the front. Sister Agnes wrote: 

In the summer of 1905, we decided on the bold step 
of starting our own paper in January, 1906, and as early 
as October, 1905, we found it necessary to begin with a 
small printed pamphlet, Mitteiluugen an unserc Sch-ues- 
tern, which may really be regarded as our beginning. 
Only those who have themselves founded a paper know 
what a progressive step it is for a society to have its own 
organ, but they also a^onc can know what work, anxiety, 
and responsibility it means for the c'''tor. One thing is 
certain, such a paper can only be of real use to nurses and 
can only develop on true lines when controlk^d by mem- 
bers of the profession. Now nursing in Germany is not 
a good school for pul)lic work. Owing to the religious 
origin of her work, a nurse still seems, and in many cases 
is encouraged to be, a person apart from daily social 
interests! How much there is f(jr her to learn, if in 
connection with all her nthvr duties she decides to run a 
paper! . 

We exchange journals with all professional and women's 
papers, we also send it gratis to all women's clubs at 
home, to some abroad, and to all Information Bureaus, in 
all sixty-one. These arc only small tniml)crs as yet, but 
we arc beginners and have had so short a time to develop 
thai, SVC have but little to ofTor when we compare ourselve? 
to our "Sister- press" in other countries. Still, we began 
with nothing; what we have succeeded in doing has lurn 
done with our own means and by our own strength in the 

' VnUrm Ijizaruskreus, January 15, 1908, and sucrecflinR numbers; 
•rticlcs on "The History of the Assrjcialion." by Sister Agnes KarU. 



The German Free Sisters 


stius^j^le for independence and prof;rcs.s, and we can only 
say ihat we are content .1 the results. Even now, in 
our second year, we are able to print a double nuTiiber 
when necessary, and numlicrlcss copies find their way 
from time to time to distant lands, winning for us new 
friends. . . .• 

The official nursing journal, of course, needed a 
name, and a symbol. The name Unlerm Lazarus- 
kreiiz was chosen, as, in 1904, after consultation with 
artists and antiquarians, a badge of the extinct Order 
of St. Lazarus had been adoi)ted as the society's 
emblem. Sister Agnes explained the reason for this 
selection as based upon the social service of the 
combatants of leprosy, and said: 

I'erhaps it may seem strar_;e to many that in spite of 
our calling ourselves "interconfessional" we have chosen 
a cross for the badge of our journal and association. It is 
an historical fact that owing to nursing being, so to say, 
the offspring of the Church, the cross is her natural coat- 
of-arms. Not the so-called "Re , Cross" — that of the 
Geneva Convention, which, out of gratitude for the initia- 
tive given by Switzerland, adoi)ted its coat-of-arms in re- 
versed colours for army nursing — but a much older cross, 
as displayed by the Order of St. John and the Knights of 
Malta. Such an old historical cross is the one we have 
chosen, a relic of the Crusades, worn by a knightly order, 
now extinct, in their fearful social struggle against leprosy. 
And as we also arc at war with social abuse, sickness, 
and sorrow, we consider we may claim the right to follow 
the advice of an artist and reanimate this symbol of olden 
times as the seal and baih^e of our earnest endeavours. 

' Reports of the Paris Conferemc, 1907. Paixrs un "The Nursinjf 


^ IIistA)ry of Nursing 

It is our c;iniest wish that our bad^e be thus worn, that 
each issue of our jounial shall carry into the world the 
true meaning of our efforts. Our motto needs no explan- 
ation. Ich dicn speaks for itself, and when one thinks 
of the many difficulties we have surmounted and of the 
still ;;reatcr number before us, the encouraj^in^ words of 
our second motto, per aspera ad astra, will not be con- 
sidered ouu of place. 

Before the as.sociation had finally adopted this 
badge, their use of it was contested by the Red Cross 
societies upon the ground that it resembled the 
Geneva Cross. It is, however, quite diilerent. 

Young as we were, it seemed to us of the most far- 
reaching^ importance that, in January, 1905, the city of 
Diisscldorf made overtures to our society to staff its new 
hospital when finished. It was expected it would be 
opened in October, 1906. Professor Witzel of Bonn was 
chosen as Director, and my first interview wi'h him, his 
medical chief, ami the city officials concemcd, was held 
in Diisscldorf in 1905. . . . The course of training was to 
last for two years, instead of the one recognised by the 
law. [The two years' course was later abandoned ior 
one year.] The four weeks* service required of the 
Sisters who were to take posts at Diisscldorf, gi\'en at the 
Friedrich Wilhelm Stift in Bonn, was a valual)le service 
for our members and gave gratifying evidence that it 
was entirely possible for them to work in complete har- 
mony with the Kaiserswerth dcacones.scs there. . . . 
That all did not come to be realised as we had hoped in re- 
gard to Diisscldorf is well known to all our SistiTs. Nor 
would it be easy to say where the fault lay. We arc in 
a transition jieriod which is characterised by special 
difTimlties in all our hospitals. There is hardly any 
Gentian liospital where the conditions lo-day arc satis- 

The German Free Sisters 


factory or promising, and things are naturally at the 
\von:t in the vast city hospitals, with their complex 
management. As the same theme with variations is 
found everywhere, it is clear that the root of the trouble 
lies in the system — in the mode of organisation of hos- 
pital work. To trace it to the j^oint of clear demonstra- 
tion of where the trouble lay, why general discontent 
and continuous change are the rule, would be the first 
step toward improvement. To us, it is of first import- 
ance to know in how far the Sisters are at fault . . . . 

We should not only be nurses for the sick, doing simply 
what is necessary for the physical care of our i)atients, as, 
in the mad race of work in a big hospital, with its under- 
stafling, is often unavoidable, but we must be apostles of 
hygiene of social progress, if we wish to fill a place in the 
life of the people. We are only useful for a few years in 
hosjntal or private duty, while we are in the prime of our 
strcngtli. And iheii.^ Then our future is in s<jeial work, 
whose full ;)ossiljilities are onl\' now lieginning to be 
recognised. True, we have not been prej^ared for it . . . 
we must see to it that we are prepared. ' 

The year 1907 brought many imi)ortant events: 
The corporation charter \vas granied; the suit 
brought l)y the Red Cross against the organisation 
to prevent its adoption of the L'lzurus-KrcHZ as a 
badge, on the plea that it might be mistaken for 
the (jcneva Cross, was decided in favour of the 
German Nurses' Association. Then came June 1st, 
when tile Imperial Registration Act for Germany, 
first demanded by the nurses at the Wiesbaden 

' Unttrm Ijizarusknn:, .-irtirlr:; mi "'I'lu lli^twry of the Assoc'ia- 
tion," liy Sistcf Agnri K.irll, in January 15, 190.S, ami succeeding 


A History of Nursint^ 

meeting of the Council of Women, in 1902, went 
into effect. 

In Alareh, 1905, the Federal Council had ac- 
cepted the draft of an act regulating the practice 
of nursing for the German Empire. On March 
23, 1907, a conference of nursing associations with 
the Minister of Education, von Studt, was callrd 
together, and on June 1st, of the same year, the act 
went into effect m Prussia. The law, as adopted, 
did not fully meet the nurses' wishes, but they re- 
garded it as a step in the right direction. For 
one thing, the state formally recognised nursing 
as a professional career, anJ lluis a weapon was af- 
forded against the worst of those abuses which had 
grown up under unrestricted competition. There 
would now be a line of distinction drawn between 
nurses who had passed a state examination and those 
who iiad simply been "examined Ijy a physician." 
If ilie public had reaHsed what was implied in this 
latter ceremony it would have been less easy for peor^le 
to be deceived as to the respective merits of nurses. 
Sucli examinations might even be based upon a six 
weeks' lecture-course given in an offfee, upon i)ay- 
mcnt of a five-dollar fee, and certificates signed by the 
physician-lecturer gave the holder the right to nurse 
the sick! No wonder that the public sometimes saw 
the resorts of such persons closed by the police ! The 
German registration act requires one year of study 
and hospital traininv^. unA t]ioui;h this is too short, 
it will act in a salutary way u])nn the im'sent six 
months' courses. Examinations are held twice a 
year in hospitals, and comprise oral and written 
tests. %vith practical v.-ork under cbt-:crvation in the 

The German Free Sisters 


wards. The examining board is composed of three 
physicians. Eleven subjects are specified for ex- 
amination. The examination is not compulsory, biit 
calls for one year's work and study in a public 
hospital or in ore reco^mised by the state.' 
Sister Agnes wrote of the passage of the act: 

Thai will remain fc^r all time one of the most memorable 
davs in German nursing, because on that day the nurses' 
calling was stamped and sealed as a secular profession. 
Much'^as there still remains to do, nevertheless this first 
le-idative act in protection of our work, incomplete as we 
hold it to be, has erected a new foundation upon v. hieh we 
may and must build to completion.' 

The conference called by the Minister of Education 
to discuss the scope and details of the law, and held 
on March 23d, was a noteworthy occasion. Ml the 
nursing bodies of Ciermany sent their representatives. 
Catholic orders and deaconess Motherhouses, Red 
Cross societies and the Diakonic Vcni)}, city hos- 
l)itals and the German Nurses' Association,— all were 
there, but out of thirty-(jne such delegates only six 
were W' a.en. Sister Agnes said: "The conference 
was a step of the greatest importance. It was char- 
acteristic that, while all the other nursing associa- 
tions present were represented entirely, or largely, 
by men, we alone, an inilependent body of wonu n, 
were distinguished by having our elected president 
lure 10 act for us." [Sister Agnes herself.] 

• Abstract of paper read by Sister Charh.lte von Caniinerer at 
the Paris Confercncr. lyny, ,,n " The^ German State Reg.strat.oD 
Art [<„ Nurses." 

> Unlerm Lazaruskr uz, .Xpril I, 1908. 


A History of Nursinof 

The act, it will be RmLiiibcrcd. is not compulsory, 
and the deaconess and K -d Cross jMothei houses were 
extremely reluctant to acce])t it. The Catholic nurs- 
ing? orders received iv with the best grace, and, whether 
they liked it better or not, were among the first to 
agree to conform to its requirements for professional 

From now on the friendly alliance with the army 
of the Woman Movement became cont inurdly a closer 

Sister Agnes wrote: "Our connection with the 
Woman Movement has developed in a gratifying 
way, and has been fruitful in its broad relationships." 
1 hat summer she si)oke on organisation among nurses 
at meetings of the Council of Bavarian Women, and 
on proper training at the p iblic evening meeting of 
the National Council of Women in Jena. In the 
autumn and winter caiiu' invitations to speak on 
nursing and its problems in man\- parts of Cermany. 
Into those years of strenuous labour we will now look 
for a moment through the medium of Sister Agncs's 
letters ; 

. . . But I am not well— always ailing, and have to 
be very careful ... hi our ofiico they arc working like 
slaves; it is too bad ami I <!< i nol know how it is to end. 
Sister — — • often looks so ill, I am afraid she will l>reak 
down. . . . We now have a very nice new Sister for the 
telephone and oflice work. . . . But we need one more 
and ha re not the money or the right person to do it. . . . 

Not long ago I went to see for the first time since 

January. It is amusing; to sec how evident it is that we 
are g.iining ground. He was always nice, but this time 


The German Free Sisters 


he was as proud as a peacock, because he had always 
known that we would make our way. He told me that 
the German rc<:;istration act was really our work, and 
that we were his best hope. . . . 

Life is rather hard sometimes, but nothing of all the 
worry can be everlasting, and so it is not worth wliile 
to take it too hard. I am very glad of the few drops 
of old ivendischem Fiirstenblut in my veins which nc\cr 
let me lose my courage. . . . 

My tour through west and south Germany was 
dreadfully fatiguing but inspiring, and those five weeks 
seem like years. Is it not nice that the Munich doctors 
asked me to speak before them? And they took my 
reproofs so wtU: I do not think doctors quite as hopeless 
a> 1 <lid. 

Saturday I have to go to a little town one hour distant 
to look after one of our Sisters, who tried to take her life, 
because she feels that she will not be able to work much 
loTiger. It is heartrending, but the doctor wrote me 
some splendid letters — he feared we would expel her — 
every IMotherhouse would do so. . . . 

A young doctor came to see me a week ago — a fine 
fellow; he is a member of our association, and I asked him 
if he would take the poor girl for his little eye-clinic and 
he promised at once that he would. Rut first she 
g') for treatment — God may help us to save her. I am 
so sure we will find the means to make the way easier for 
all these poor overworked girls, and in time we will find 
them a convalescent home. Life is a dreadful thing, 
init it is fine to grapple with it and get the better of it. 
I sometimes feel like little David with the giant Goliath, 
but I think in this battle a warm heart is the only stone 
to thr.'^u 


A History of Nursing 

I am in bed for a little rest, so I have a quiet hour after 
sending some notices to the papers about our battles won. 

Geh. Rath in the Department of Education told me 

to send them, and I think it is a good thing to do. Some 
of them always take our slips, and I hope to find a million- 
aire for another legacy. 

In April I have to speak at the Bavarian Women's 
meeting about nursing; in May I must go to a committee 
meeting of the National Council of Women to which I 
belong; in June, Paris — so you see my life is full to the 
brim. I had a good iight one c\ .ng not long ago with 
all my dear enemies in the Society of Social Medicine, 
Hygiene, and Medical Statistics — a discussion of Dr. 
Eugen Israels' paper on our registration act. . . . The 
fight will really only begin in the next few years. This 
was only a little taste of it. 

The comedy about our badge before the Schoffcngc- 
richl is just finished. 


How I would like you to see our ofTiccs now, with 
ten salaried Sisters in them, and so many new inventions 
and things! 

My tour of lecturing was full of interest and pain. I 
saw heaps of authorities, and so many nurses. I think 
I never before realised as I did this time hov/ sorely 
they need us. We can do a good deal for them, but 
alas! never enough. And how they die; that is sim- 
ply heartrending! So many suicides! And so many 
dreadfully ill, and most of them die too young! . . . I^ 
had a strenuous time, four weeks in eleven places;— not 
more tli;in five or six hour-,' sleei) and working hard all 
the rest of the time— lectures and visits. 

lis lyii inc rt5SuCiu.i,iij; 

1 ^1 f- J- 


The German Free Sisters 


in Hamburg, Bremen, Baden, Wurttemberg, Saxony, 
a group centre in Riga, Russia, including Gcmian 
nurses all over Russia who are member'^ of the 
German Nurses' Association, and in Frankfort. 
The groups are largely self-governing, and form 
nuclei for the furthering of local interests and 
llie study of local needs. So steadily grow the 
aftiliated societies that detail must not here be 

The modern era is in full swing in Germany. Tlie 
rush to great cities is steady, industrialism has 
marshalled its problems, and the free Sisters are 
responding to the call for the many specialised forms 
of social service. District nursing, in its older form, 
is still in the hands of the Church, but the newer 
lines of preventive visiting nursing are being directed 
by the municipalities, and nurses are being appointed 
to give instructive care to the families of tuberculosis 
cases, especially of those sent to the sanatoria main- 
tained by the government insurance; to follow up 
alcoholic cases and their families, and to watch over 
the well-being of infants. By 1910, fifteen German 
cities had appointed women, many of whom are 
trained nurses, as police-assistants. Their duties 
call for the finest combination of womanly initiative 
and professional tact and skill. In the vast need for 
many such assistants is a suggestion of the new paths 
opening before the modem German nurse. School 
nursing, first established in Charlottenburg, was still, 
in 191 1, in its vor^' early stage of development. In 
two h gh schools for girls in Charlottenburg, nurses 
were teaching hygiene, simple nursing, and the care 

01 iniants. 

,„• 11,- fl-r 

iMcxiiy ciioLnco zitiibCoi c^^cc*».iiij, i-i 


A History of Nur.sin<r 

the Diakonie Verein, gave similai- courses. Nurses 
were giv-ing talks ami .Icmonstraiioiis on nursing in 
the home in girls' boarding sehools, to classes of 
wives and mothers of well-to-do families, and to 
groups of factory girls. There were a few em])Ioycd 
in factories and department stores to guard the health 
of employ es, and a few in the employ of hotels and 
ocean steamers. On the whole, Germany had not, 
at the time this was written, utilised nurses in pre- 
ventive work as fully as she might have done. 

Among the nurses who have entered actively into 
fields of social reform none has stirred up more active 
controversy than Sister Henriette Arendt. who is 
kJiown as the lirst woman in Germany to hold the 
position of Polizeiassistentin. A woman of i are sym- 
pathy, fearlessness, and encrg>', she has been described 
as one of the most strikmg figures of the modern wo- 
man movement. For a number of years at her post in 
Stuttgart, her vigorous altruism flew far beyond her 
prescribed duties, and voluntarily, in her free time, 
she followed trails wliich unearthed obscure forms of 
cruelty to and mistreatment of children. The socie- 
ties existing for the protection of children took offence 
at her revelations, and wlien she made public her 
proofs that there was a genuine slave trade in children 
for immoral i)urposes which ycarlv swallowed up 
hundreds of Httle girls (usually illegitimate waifs), 
and that police departments and charitable societies 
were alike silent in its midst, bureaucratic dignity 
was outraged. She was officially ordered to cease 
her e.xtra-otTicial work. This was impossible to a 
woman of her temperament and impatience with slow, 

moderate y'v-' of 'fi^^i- — ...u^. „ - . 

"■■-' ^ --.i-aiii.^ v.iLii vviong, unci iier cnli- 

The German IVee Sisters 


cisms provoked counter personal criticism and 
recrimination. In the resulting clash of disinite, 
Sister Ilenriette resigned in order to devote herself 
wholly to the salvation of the children in whose cause 
sh.' had enHstetl, and undertook to supjH.rt herself 
by lecturing and writing on her subject, making her- 
self, meantime, responsible for several hundred 
rescued children. (By 191 2, over 1200.) 

A striking and picturesque accompaniment of the 
new movement in nursing is the wonderful growth 
of hospitals. Like magic, new h()^i)iials o{ the most 
remarkable beauty are s})rin ing up in or near Ger- 
man cities, built like village colonies in parks and 
gardens, of immense extent, able to care for thousands 
of patients, of the most highly perfected details of 
architectural charm and fitness, meeting scientific 
demands for treatment, speaking the last word in 
inventions, apparatus, and labour-saving machinery, 
and, withal, showing a captivating attractiveness of 
u-ard interiors, bringing the whole force of combined 
beauty and usefulness to bear on the problem of 
treatment. These new hospitals will recjuire hun- 
dreds of women, trained to the highest standards of 
the nursi-^g art, to staff them properly. Great 
changes are already going on in them. An item in 
one of the daily papers for 1906 said of the Charite, 
which has been largely remodeled: 

A number of tlie Kaiserswcrth deaconesses were re- 
culled last year, and this year the rest have gone. The 
Sisters from the Clementina House in Ilanuver were the 
next to go. All the posts are now filled with Charitd 
Sisters. The nursing is now unifipfl [but \v\iU nr^ nijr-- 
ing head !], and is directly under the control of the direc- 


A Plistory of Nursing 

tors of the hospital, insu ad of bciIlJ,^ as before, carried 
on by nurses from dii'fcrent ins'ilulions, each group 
being under the control uf its own school. 

So moves the world ; but one must offer the tribute 
of a feeling of sadness to see the Kaiserswerth deacon- 
esses leaving old Charite, where Mother Fliedner 
brought them long ago on her wedding trijx The 
hospital directors arst tried an entire permanent 
stafT, then, with ward Sisters, cpen-,d a training 
school. The educational standard complies with the 
registration act, but the school is not a model. Charity 
is distinct among German hospitals by its refusal to 
liave a woman superintendent of nursing. 

The mosi ])ressing j^roblem to be worked out in 
thrse splendid new institu'.ions is that of the ]>roper 
organisation of the department of nursing. At 
present there is, in some (juarters, chiefly among the 
authorities and their subonhnate ofllcials, a distinct 
unwillingness to give this department its ])roporti()n- 
ate share of imi)ortance and ;idminisirat i\c ])owtr. 
Though, with Ihe exception of Charite, the hospitals 
appoint Matrons, tluy do not give them tin ir right- 
ful position, nor do they secure for them a training 
and <'xperience which will enable tluin always to 
handle ind develop their aork as Sister IlOlene 
Meyer has hwu able, at Dortmund, to do. 

The most serious individual problem facing the 
r.erman nurse is, without a doubt, that of overwork 
The saying sometimes heard, wliose origin no one 
knows, that a nurse's working life is ten ye;irs, must 
have originate (1 in (cntral ICuroj-e. In nio;,, Alfred 
von b;ndheini,a ineiiiber of t lie Au.strian rarliaiiieiil, 
published a book called .Sahtli .'Ei^roruvi: Anf[:<iht' 


The German Free Sisters 


unci Bcdcutung der Krankcnpjicgc im modcrnen Staat. 
In this lie sludies statistically the morbidity and 
mortality of nurses, finding the death-rate amon^' 
thiin to be twice as high in (icrniany and Austria as 
that among other women of corresponding ages. 
Analysing his figures, he finds the highest mortality 
MHong the Catholic Sisters of Mercy. Some of these 
orders have from seventy to one hundred i)er cent, 
of deaths from tuberculosis. Taking all the Catholic 
nursing orders in the (jcrman-speaking countries 
tiigether, he finds their average death-rate from tu- 
berculosis to be sixty-three i^er cent. As youth is 
susceptible to overwork and infection, the mortality 
is so much greater in proportion as the Sisters are 
> -linger, and he states that nearly all the Catholic 
Sisters included in his incjuiry died before they were 
fifty years of age fp. 165). He found the tables of 
sickness and disability astounding. For every one 
litK.dred Catholic Sisters the time lost through illness 
in one year amounted to something over 5S5 days 
':■ irN). He found the morbidity and mortality 
among deaconesses. Red Cross, and other secular 
nurses to be considerably less, yet, as many such 
women leave their orders, he considered that they 
v re lost to statistical research and that, if they 
• "u'd be found, the actual i)ercciitage might be 
greater that; his results. He gives four explanations 
of the high morbidity and mortality figures of the 
religious orders: 

(i ) Probationers arc taken too young, and physical 
t ..iiiiinations are not rigid enough; they arc often 
atliiulted w ith inherited iliseaseor delieaf e ])hysiques. 
His conclusion is tliat. solely on ].hysiologicaI 


A History of Nursing 

i^^rounds, as a hy^'icnic nile, women should not b" 
adiniUcd lo liospilal irainin.i^^ btforc Uvcnty-one c 
twenty-uvo years of ai^e al the least. Below this, 
the dan^'er to health increases in a ratio directly 
])roportioned to the <;reater youthfulncss. [This is a 
])oint that mii^ht well be noted by American law- 
makers, who alini^st invarial)ly dislike the a^c limit 
set for state examination and have in many instances 
reduced it by from one to three years from that orig- 
inally set by nurses.] (2) Unhyj^ienic conditions of 
living. (,v) Stoojjcd or cramj)ed attitude and un- 
hygienic dress. (4) Overwork anci exhaustion. 
P>ut, if (ierman-speaking nurses, or the Sisters them- 
selves, were to arrange these four points, they might 
properly alter their ordcT and jilacc overwork at the 
head of the list. 

Von Lindheim's statistics have been followed by 
those bt'gun iiti(k'r lheaus])icesof the ( jcrmaii Nurses' 
Association, which are the only recent ones extant. 
In the imperial insurance of Ciermany, nurses, as a 
whole, are not amon^' those work rs for whom it is 
eomi)ul>or>-. If the_\- were, full statistics of mo^-bid- 
ity and mortality would l)e kept by the state, but 
they arc ir the voluntary classes — these who may 
insure if they w i h. (Asadctail, most of the members 
f'i the r.crman Nurses' Association do enter the stale 

p"'rom *he first, one of Sister Agnes's strongest 
wishes was to eomjiilc a census of health londitions 
among the nurses. This she finally accomplished 
after strenuous exertions. From her reports, which 
we cannot give in full, the following significant cx« 
tracts are taken; 

The German Free Sisters 


nd- who, for a decade or more, have lived the life 
uf iho Cicnnan trained nurse, and have worked with and 
fur nurses, need no figures to tell them how it stands with 
the health of these women. The tra^'cdies met in tiie 
dav's experience, the letters received with their heart- 
rcndinj^ stories, speak a lanj^age that moves and con- 
vinces, but that is sj)oken to us alone and is not meant 
for the public. In order to prove what we have ofien 
cnou,i:;h declared, and to brini; about, for the reforms 
(hat we need, measures far more enerj^'ctic than any we 
have had hitherto, statistical evidence is essential, and 
this has loni; been lackinj;. 

Suon after our foundation, we bet;an notinj^' in the 
annual reports the state of health as well as the v/orkin?^ 
eflicienc y of our members. It was a diflicult task, as we 
early encountered the obstacle common to all statistical 
inquiry, namely, that many blanks remained unfilled. 
This has now been rectified in ^;reat measure by our by- 
law makinj^ failure to answer our questionnaires a rea-soa 
for loss of membership in the association, and by the 
exercise of endless patience and manifi )1(1 warni-ij^s. But 
these annual reports .i^ave only a picture of ihe serious 
illnesses at the time biinj,', not a general survey of the 
complete status of the Sisters' health. To show the 
latter in a really viduable form a longer period uf time 
was needed, in (iriUr liiat I'.nater mimbers might be at 
nur disposal. With the rapid growth of tmr membership, 
this has with corresponding rapidity become possible. 

In January, i<)t)<), we began an iiuiuiry, and by t ha 
end of the year 2500 re] )lie/; Wire in our iiand;;, so that our 
statistical analysis could be begim. On account of the 
k'reat mass of qncstioniuiires to be worked over, we could 
not attempt sending ba( k those (hat were incomi>!e(ely 
ii'!''d out. i-"or llie futtire they hail in' filled out by 
fv» ry new member upon admission, and so any gaps in 
answers be avoided. Hut will t ven such records givfl 


A History of Nursing 

the whole truth? There lies a second serious obstacle 
to tile statistical demonstration of thi.,, t.ic weightiest 
Iirohlem of our professional life. The Sisters will fear 
imperiling their acceptance into the association and their 
appointment to positions, and try to protect themselves 
by their answers. Nor can one always say with confidence 
how much of inaccuracy in reply is intentional. One 
must have lived with nurses for some time before realis- 
ing that, while there are always those who comi)]ain 
readily of t'very little ailment, there are far more who will 
not yield even to serious illness until the last endurance of 
the will has been exhausted — who never think of their 
own health until it is too late, and who i^^uore or overlook 
in themselves symptorns whose seriousness they would 
instantly recognise in their patients. 

There may be those who, after reading the following 
statistics, may assume that only in our association are 
things so bad, and who may accuse us of not earing prop- 
erly for our members, in not providing work for them. 
However, a^ our association is only eight years old, and 
as its aim has been to gather together the self-dependent 
women in tlie nursing profession, rather than to bring 
new elements into it, it has been a nucleus for the union 
of all women who, entering the work of nursing 
from the most dilTerent directions, have found themselves 
compelled sooner or later to stand up,on their own feet. 
A nunil)er of the 2500 meinhers, wlu)se classifunl health 
records fiiIU)w, had indeed been attached to several other 
institutions, as maii\- of them had been m tlie profession 
for some years Ik lore joining us: 1535 ha^-e belonged to 
one other institution; j(>i to two, .and 204 to .several 
others before entering our organisation. To specify 
more closely: ^>>7, had been in deaconess houses, 653 
undi r the Red Cross, 207 in the Diakonio Vcrein, 2(X) in 
the Victoria Mouse, 7()< in city hospitals, 142 in the 
lIaTnl)urg-Rppcndorf Jlo^iMtal. 74S in other institmioiis 


The German Free Sisters 41 

and associations. 122 in university hospitals, and ^sx 
in homes [for private duty]. (Many of our 
intnihers still belong to one or another of these institu- 
tions, as a professional organisation is simply supple- 
m.ntary to them all.) ^ 

The conditions of health of the 2500 Sisters, then 
with their different ages and varying length of time in 
theseryiee n ,y be accepted as a fairly typical picture 
ot the health conditions of all German nurses here bet- 
Ur, there worse, according to local conditions and the 
(ktjrec of care taken of them, the greater or less shortage 
of Sisters, and the sufficient or insufficient numbers of the 
worKing staffs. 

Whrn our organisation was founded il was well and 
early known to those who had been some years at 
work, that the health of German nurses was sum as to 
give extraordinary cause for concern. For thn reason 
our membership requirements have only called for "alMl- 
ny to H-ork" instead of the "perfect health" that is 
always rightly required of probationers. It i. ,-reatlv to 
be desired that, while the pracuee of nursing eontimus 
to be as dangerous to health as it now is, this requin- 
'li-'l for probation should be more firmly enforced and 
"■^untamed than is actually the case. ( )ur first .lealin^'s 
v.ere with already in the work, an.l even thoirT, 
>">ee our foundation, we have directed an increasing 
""•"'ht ,,f appheants to various hospitals for training 
n. vcrthelcss the responsibility of d. , iding the phvi.'d' 
'tness of candidates rests not with us. but with the 
'"sintais. The following re,>ort, in manv places, ealls 
for special att. lUion to this point. Certainly the results 
H allows in this connection arc> astonishing. 

n ^ urs, ^4^^, ,-,t.iti- t||;it ,^t the time of 
; ir rntruKv into the nursing profession they were 

i'Vliy !?'"■ r*:, ?^ ^''''''"' ^'"'' ;^'"-l^i"^; '-'HTgy to 
•^' ''''' ~"~ "•••"vt; 20 diseniied their con- 



A History of Nursin 


dition as "pretty good"; 4 had pulmonary weakness, 
12 had weak hearts, 3 were neurotic, 6 had various 
serious aihnents. Thus, among 2500 Sisters there 
were only 20 whose health was not quite perfect, 
and only 25 who were positively unhealthy, when 
they took up the calling. These, then, should have 
been withheld from entering it. It is possible that 
among the 32 who gave no answer some may have 
feared injuring their j^rospects by answering this ques- 
tion, and their number would increase the figures given. 
But it is by no means in accordance with facts that, 
among 2500 nurses, only 45 should have been unable to 
claim perfect health upon their entrance to nursing. 
The number of women of extremely defective health who, 
in spite of medical examination, are admitted to the 
profession is very much greater than this. Between the 
time of entrance into hospital and that of joinmg a 
professional association this number diminishes, so that 
the census of our members would give too favourable a 
])icture of condilions, if the original conditions were not 
also considered in forming judgment. A considerable 
number of the least strong and well wo- Id naturally be 
dropped out during probation, but far too many would be 
retained because of the hos])itars need of numbers, and 
would be taken along from year to year until ihey were 
entirely worn out. Wehad supi)Osed heretofore that the 
share of this element, which had been unpromising from 
the oul.ri, had l)een a larger one in weighting our burden. 
The figures thai follow thus take on an added significance. 
Hereditary tendency to disease is anotlier point of 
miirh gravity. We inquired only as to tuI)erculosis 
and nrrvous disorders: 254 admitted the former, 
and 70 the latter, in their family hist<'ry. However, 
among these onlv 4') I'ases of tuberculosis and 8 of ner- 
vous tnnibU- liavc developed. 85') of our Sisters had had 
another occupation previous to nun.uig. To speiiiy 


The German Free Sisters 


more closely, 62 had been married, while 627 had worked 
at one, and lib at two oilier ()ri;u])a lions. As, however, 
none uf iheir other ])ursuils could l)e re^-arded as inimical 
to licalth, it seems unnecessary to consider them in 
further detail. The clearest li^ht upon conditions of 
li'.dlh is s^'iven by the table of the a.i^e of entrance into 
nursin.L,'. The admission of eighteen-year-old girls is 
not unusual, even though tv.'cnty is supposed to be the 
usual age. In our inquiry we found 3 who were ad- 
niiued at 15 years; 13 at 16; 4() at 17; 563 between 18 
and 20; and 940 between 21 and 25 years. 

The age of 25 has been pronounced the most desirable 
iiy various authorities. In foreign countries, where good 
nmdi lions are found, 22 and 2;>, are usual for admission. 
TiuTi'fore, when 1568 of 2500 Sisters began nursing 
before the 25th year, what follows need not surprise us. 
The query as to working cniciency is, to our regret, left 
unanswered by 125 Sisters. Of the remaining 2375, 
1044, or 77.8 per cent., state that their working efTiciency 
i^ unim])aired; 290, or n.6 per cent., that it is impaired. 
Unlit to work are 141 or 5.6 per cent.; of these, 47 are 
>i'' solutely unable to work, and in the case of 25 of them 
ihis will be a pennanent condition; 94 are unable to 
work at times, and 3 have died since the questions wcro 
answered. Our table, ■ showing the age and the number 



No. of 







Can work 







at times 




1 .s > 





















I -'4 




J I -25 












3' 35 






4' J.S 







C.) i ills ( 




A History of Nursing 

of years at work, with the present decree of working 
efficiency, sets forth the condition of things most clearly. 

From the statistical tables, which space does not 
permit giving in full, we find that overstrain has a 
bad pre-eminence — 1050 nurses answered the ques- 
tion as to the exact time of its appearance. Among 
them, 2/7 were overstrained after one year; 180, after 
two years; 163, after three; 106, after four; 88, after 
five; 64, after six; 29, after seven; 30, after eight; 18, 
after nine; and 31, after ten. Then followed tables 
showing the relation of age to impaired efficiency, 
and the proportion of those fully unable to work, 
and those able to work at times. 

So by the cnrl of ton years' nursing 986 Sisters out of 
1050 were overstrained, and upon reaching the age of 
thirty years 739 out of 1050 were overstrained. Rarely 
was the first overstrain repaired. Only too often did it 
constitute the starting-point of manifold ailments which 
were frequently scarcely noticed until they suddenly 
declared themselves in their full, perhaps fatal, might. 
Or, again, the constant effort to pull one's self together 
under chronic brCvakdowns means chains of painful 
suffering usually borne heroically in silence— for who 
wants a nurse who is not so strong that she may be 
leaned on wholly without thought? And yet nur.scs 
must not only support themselves, but even assist in, or 
assume outright, the support of relatives. The whole 
gamut of women's heroism is sounded in this, the noblest 
and most inspiring, but— in Germany — most cruel 

The Sisters describe their present state of health as: 
good, 1891; satisfactory, 161; poor, 149; vaiiabie, 20; 
not s.itisfactory, 4"^; bad, iT). 

Others dcscrilic tliemsclves as follows: 

The German Free Sisters 


Worked-out and fatigued, 42; overstrained, 14; need 
vacation, 16; nervous, 28; ill, 27. From 93 no answer 
has come to this question. 

That the Sisters do not estimate their health quite 
according to their working efficiency is evident from the 
fact that 1944 reported themselves fully equal to the 
performance of work, while only 1891 called their health 

We attached special importance to the statement as to 
f)hysical condition during the first year of work. This 
was unanswered by 141, or 6 per cent.; of the others, 
1544, or 61.6 per cent., answered that they retained full 
working efficiency during the first year; 504, or 20 per 
cent., were temporarily overstrained; and 311, or 12.4 
per cent., had illnesses. We inquired into attacks of 
ilhicss with the following result: 959, or 38.4 per cent., 
had always been well; 741, or 29.6 per cent., had been 
ill once; 800, or 32 per cent., had been ill frequently. 

After reading the foregoing one cannot be surprised 
that 280 of the Sisters admit having been refused by the 
private life-insurance companies. This number would 
!io even greater, were it not that many have not applied, 
because of straitened circumstances or the high premi- 
ums required in late entrance. The number of accidents 
is surprisingly sn;all and it is probable that onl}' the 
serious ones were reported. It is also evident to those 
having intimate knowledge tliat mild forms of many 
other troubles have not been mentioned — as, for instance, 
slis'ht cardiac neuroses, for otherwise our figure "80" for 
cardiac defects would not be nearly right. Cardiac 
disturbance is the rule among the elder Sisters. 

While 1618 have not exceeded the t^mth year of nursing 
service, there are 755 who have worked longer than tluit, 
some even up to the thirty-fifth year, and two have nursed 
i" ir forty, tliough one of these two is now whollv incap- 

auie 01 worK. 

1 ne oiner sun >:iaiiu:3 wtiitvn 

^. 1 1 II- i\,.ii\^y f 


A History of Nursing 

though no one else would a^ree with her. We were 
especially struck by the prevalent optimism, as we col- 
lected the rci)()rts of the physical condi'ion of those who 
had entered hospitals l>cfore cii;htcen. Only ten of the 
sixty-five admitted unsatisfactory health. The others 
designated their health as " K'ood, " althouKh we happened 
to know personally in the case of seven that they had 
serious troubles which threatened them menacin^dy. . . . 
The very saddest chapter of our theme is our death- 
roll. ..." In all, thirty-five of our members have died, 
ten between the a^cs of twenty and thirty, after from 
one to five years of service; nine between thirty and forty, 
after from six to ten years; and eleven between forty 
and hft>-, after from eleven to fifteen years of nursing. 
Among the causes of death were nine suicides. . . . 

Of the mournfully high total of suicides it must be 
especially emphasised, that in no single instance did any 
love affair or recklessness enter as a complication, and in 
only one instance were there any domestic troubles other 
than illness. In some cases the cause was unmistakably 
acute insanity; in others, physical wreckage of one or 
another form", sometimes traceable to heredity, some- 
times to physical exhaustion or illness. That we should 
continually find cases of alcoholism and morphinism 
among Sisters is not surprising. Those who, exhausted, 
must still keep on working, grasp at every straw of 
support, and pain, sleeplessness, or mental depression 
accounts often enough for the first step toward 


In regard to the considerable list of tubercuiosis cases, 
it must be plainly stated that, taking into consideration 
the fact that nurses are so frequently undernourished 
and overworked, there is by no means enough care given 
to seeing that nurses placed in tuberculosis wards are 
r.o.t. nredisoosed to this infection. An insufficient number 
of nurses is usually the cause of this criminal neglecU 

The German Free Sisters 


How many of our l6o tuberculous Sisters must yet 
txpiate il with their hves? 

Remembering that an old medical chief in a Mother- 
house who, for thirty years, had held a leading position 
once declared that fully one-third of the Sisters had car- 
diac disorders as the result of (jvcr-excrtion, but that 
he was helpless to prevent 't under the circumstances, 
we need net wonder at our six cases of heart disease. 

Our association originally expected to reach not so 
much the younger generation as those of longer activity, to 
whom such an association would mean much as a sup]iort 
in thi' struggb for existence. But, although individual 
ui: tances of prolonged nursing service occur, the numl)er 
of those who remain long in the profession is so dispro- 
portionately low that the average working period for the 
2ynt Si;^ters is only eight years and six-tenths! 

In OUT few years of existence we have gathered small 
sums for assistance in sickness and convalescence, but 
we need hundreds of thousands, yes, millions, in order to 
rtlicve adequately the distress hidden behind these 
fi,i,'ures. May the Sisters learn from what we have here 
set down; may the eyes of the public, the directors, the 
physicians be opened, that all of us together may help to 
make things right, but, above all, for the future, to 


besides the burden of invalidism, Germar nurses 
are exposed to the menace of poverty, more, jjerhaps, 
than any other class of workers in the empire, because, 
so far, liiey have been left out of the elaborate social 
legislation which Germany has enacted to ]jrotect her 
people from want. Tliis neglect is leadily explained 
by the swiftness of the change in the nurse's position 
Iroin a suj)])ortcd member of the Motherhouse family 

! Kt.rm I.a-zaruikrcuz, May 15, lOio, giver, the full report. 


A History of xXursin*; 

to a solilarv worker. Us sharp lines and contrast 
to the state care expended for other workers, though 
keenly realised by nursing leaders, were only recently 
brought home sciuarcly to the public by a ver> uii- 
portant contribution to social literature, a book' 
setting forth the whole ])resent relation of German 
laws of all kinds— laws of contract, of hours of work, j 
of insurance, of misdemeanours, etc.— to the nurse 
as a citizen, woman, and worker, and showing that 
she is now tied in a sort of legislative patchwork not 
framed with reference to her, and in which she has 
been caught, as it were, unintentionally. 

The story of this book's writing is especially in- 
ters ting. Praulein Reichcl, while taking the course 
in a Ilandcls-IIoclLschnlc, was required to prepare a 
thesis on "The Legal Status of the Nurse."^ Sho 
knew nothing whatever about it, but began visiting 
hospitals and nursing institutions to inform herself. 
Ilowevei-, she found an inmiediate obstacle in the 
Sch-wcigcpflicht rigidly imposed upon nurses in in- 
stitutions, never to speak of any of the details of their 
work or training, i'his reticen-e, indeed, was so 
thoroughly impressed upon them that many sutfercd 
actual legal injustice on points as to which no law- 
would compel them to silence. As the ' ' free nurses" 
also were generally quite in the dark as to their legal 
status, Fraulein Reichel entered a training school as 
probationer, and worked through several institu- 
tions until she had acquainted lierself with every de- 
tail of the information she was seeking. As she did 
not feel nursing to be her career, she did not finally 

. .. . . . T^ 1. -1 

' Dcr IHcmtvcrtrag der Krankcripjieger inncn, uy <.Li.xii^'Z\^ r.;,:-::-. 
J. n:i, lyio. 

The German I'Vee Sisters 



enter the profession, but wrote her thesis in a style 
which makes it most valuable to nurses. "Except 
in tlu' penal code," she says, "nurses have been for- 
gotten by the lawmakers." And Sister Agnes asks: 
" I low many of us knew, before this, that we ton, as 
well as the midwives, stand, as a famous midwife 
has said, with regard to certain penalties, 'with one 
foot in the grave, and the other in prison'? " 

The absence of systematic provision for (-''ronic 
invalidism is clearly shown. Fraulein Rcichel found 
the general belief, that nurses belonging to Mother- 
houses were cared for under all circumstances, to be 
erroneous. At a notable meeting of women in Berlin, 
in February, 191 1, she spoke on the findings of her 
i:;vestigations, emphasising the nurses' unprotected 
condition, the urgent need of a minimum standard 
of payment, and the extreme overwork — a foi.rteen-, 
fifteen-, even seventeen-hour day being frequent. 
Sifter .Xgnes Karll followed with her story of the 
revelations of ill-health among nurses. She urged 
raising the age of admission to twenty-one, a more 
tb.orough physical examination, good and nutritions 
food in institutions, sufficient time for rest, a well- 
rej^'ulated night duty, and timely oversight of nurses 
to avert their physical and mental ills. She also 
pointed out an unanswerable proof of overwork in 
the excessive number of patients given to one nurse 
.n hospital duty, usually from ten to twenty, ' — rarely 
as low as five. Besides breaking down the nurse, 
such numbers make the best care of patients impos- 
sible. The audience of women listened in deepest 

three patients. 

VOL. IV. — 4 


A History of Nursing 

sympathy. In the discussion, Fraulein Ludcra 

spoke of nurses as "the pioneers of professional 

women workers," and as thus having special claim 

to aid and encouragement in their reforms. Tlie 

meeting closed by passing a resolution oiTered by 

Fraulein Lischnewska, calHng upon the siaie and 

federal governments to legislate for the projection 

of nurses according to modem ideas, and u]Mm city 

governments to examine and so regulate the work ot 

nurses in institutions as to secure tluir efliciency, 

their good health being a part of pubhc hygiene. 

As a basis for such regulation, tlie resolution asked 

for an ofiicial investigation into the conditions of 

nursing. ' 

This publ, , meeting made some impression m higl: 
places, for, soon afterward, tliere appeared incident- 
allv in a ministerial paper an order from the Rcgicr- 
unj^spmsidcnl of Potsdam, von der Schuleiiburg, to 
the elTect that m all hospitals belonging to his dis- 
trict, the work of female nurses sliall be regulated so as 
not U) exceed ten or ten and a luih' Imurs daily. This 
shows that tlie criticisms reached a -nark However, 
the comment added to this order, namely, "that the 
complaints v^ overwork uttered by nurses ])robably 
originate with those who are either phy.sically unfit 
for their work, or who lark the spirit of remnu iation, 
shows how little accurate knowledge exists as to tin- state of alfairs. 

Si-.rer Aimes believe^ tliat the next ten years wi,i 
see the real devcloimient of Cerman nursing. Otu- 
rial figures sho a great iiuivase in nvimbe.s. In 
i^^.,5 the hnpcrial Register t^^'i 'h^' nunib.r nf {.•male 

■ UnUrm l.iuaru^krmz, M;irrh I. I'lH. 

The German Free Sisters 


nurses at 43.946; in 1907, at 74,986. As the growth 
cf rehgious orders is not rapid, this signifies an aetive 
trend toward secular professional nursing. The 
total probably includes the attendants in a'sylums, 
indicating a high proportion of ill-educated and 
poorly-trained women. About twcnty-si.x thousand 
m this total were Catholic Sisters; a])out twelve 
thousand were deaconesses; tlie Red Cross counted 
between three and four thousand; the German 
Xurses' Association three thousand, with numbers 
H: ing yearly. 

The National Council of Women of Ck-rmany, in 
I'Hi, numbered two hundred thousand, and they 
have set the nursing ques -n on their cak-ndar to 
nveive unremitting attention and interest mitil the 
-'■■ itliening and upbuilding of the associations so 
-nly needed by the army of j^rofessional nurses 
iiall have been completed, and the politico-economic 
"nancii)ation, which they so urgently need and lo- 
wird which they are bravely presiding, si^all have 
b'HH attamed. In 1912 the International CouncU 
('! Nurses' meeting in Cologne gave to view in high 
n!: ; the strong womanliooil, earnestness, and noble 
ain^ of the German Sisters, and Iutc Herr Rr^icrunps 
u. \rnlizimilrath Dr. II. IK eker, of Stras.sburg, read 
;' piper on Overstrain amor - Xurscs .so weighty in 
'• ^ ■ nnclusions that its infl: .ice must prove ejjoch- 
!:iaking ur reforms. 




Switzerlard. - The first trainin,"; school on the con- 
tinoiu fimn(k'(l on "free" jtrinciples was that of La 
Source in 1.S59 at Lausanne, vSwitzerland. It was 
tlie creation of Mme. de Ciasparin — who bequeathed 
a large sum for its maintenance — and he husband, 
and by its charter was named "The Normal Evangel- 
ical School for Free Xi:rses." Thoiitdi it was not 
strictly secular, springing, as it diil, tr ni deeply t ■> 
vout motives, it was intended to oiTer serious-mind( cl 
women an alternative to the religious orders, with 
which the ardcTit ])rotestantisni of Mme. de (lasparin 
was not in sym])athy. Its founders refused to exact 
celibacy from the candidates, to impose a religions 
dress, or to use the title "Sister," while they em- 
phasised ihv'n advanced economic views by making 
the nurses individually free as scK^n as they Ird 
taken their course, and by insisting on the Iionoural^k' 
(juality of work done for wages, and i>n the- nurse's 
right to enjoy i;er wlmle earnings and direct lur 
own career. This unusually free and bold atlitiuK' 
made till, t.ehool to the eonliiu'iit of ICurope \sli;r 

^IrJ I<'r\''i; wru; Oi !•" in t| ' i ti< 1 ' iiiit it Ir^ilc ri ti V 1 1 11 ( '(l 

'History (}J Xtirsitif^, V 1. II., p. 73. 





f La 


' ce- 








even more elementary on the professional side, as 
fiir a number of years it had no hospital training, 
but tauglit its pupils in out-patient work and in 
private duty. In 1891, under the direction of a 
physician, Dr. AI. Krafft, some hospital service began 
l( develop in a small way, and will doubtless grow. 
$ Good theoretical instruction is given, but "training" 
a> understood in i)rofessional schools does not exist, 
nor are the pupils well i)rcpared for executive posts. 
La Source may justly pride itself on the number of 
women of exceptional distinction of character :\nd 
;;':'ility who have come to it, and they, in turn, cherish 
iii».^L'!y the high ethical ideal ujjon which the school founded, and believe in its free constitution. Its 
pupils are carefully chosen, about twc>-t birds being 
\\( 11 educated, whereas in some vSwiss training schools 
•;!i'.ducated women seem to be preferred. A visitor, 
nv'eting the pupils in training at La Source in n;i(), 
was impressed with the admirable personalities and 
superior types of the women she saw there. If 
ihc schof'.l is meant to live up to the tratlitions of 
it' origin it will develop on the lines of the Bordeaux 
nursing movemctit ; amiilify the Matron's jiosition, 
,'vi' up '.iiidcrgraduate private duty, and grade tlie 
1 Tactical work. 
There is a traitiing school iti Hcrtic. uiuh r the Red 
I Cross, foundetl in lSi)(), and one in Zurich, managed 
Ijy the Society of Swiss Women, fouiidcil in i<)oi, 
^ tlie former giving two years' and tin' l.itter three 
jycars' training. These institutions lia\c furtncd an 
' ' ■"•iation of nurses, but it i wholly under ini'ilic-al 
:<.j], and organisation in may bj said 
I to he in a state of rigid formalisni, tlu nurses not yet 


A History of Nursin 



ng initiative or leadership among themselves. 
There are also deaconess Molherhouses, whose 
members are found in many hospitals, hardworkmg 
as always, and doing be. uUful work, fmished, eon- 
scientious, and thorough. , ,, u a 

There is another secular training school attached 
to an institute of many interesting characteristics, 
namelv, that of a Catholic order of nuns at Ingen- 
bohl ' This order is young, founded about sixty years 
ago and is presided over at Ingenbohl by a Mother 
Superior of a splendid type, cordial and trank, in- 
tensely alive and keen. Both teaching and nursing 
are well established, the latter in a good hospital ot 
elghtv beds, and the teachmg Sisters all take the 
nurses' course so that they may continue to hold 
the'theoretical work m their .ands. The nursing 
methods are modem and excellent, and the secular 
pupils are not overworked. Both nuns and nurses 
carrv on their studies and prayers as much as possible 
in th.e beautiful garden of the institute. The Ingen- 
bohl nuns first opened, in Switzerland, the question 
of state registration, as many of their Sisters worked 
in (lermanv and felt the mlluence of the German act 
They arc Jordial and responsive to the inteniatumal 
Kka and may be rightly regarded as a centre of 
ardent and zealous progressiveness in nursing 

education. , 

Switzerland has manv fine l.^si.itals, well managed, 
and, Ml the mam, well nur.ed. though it is obvious 
that, in some of them, overworu i the rule for the 

nursing slalT. ^ , 

The example and mtlucnee of the t.erman Nurses 

Association seem likely to guide or colour, uncon- 






sciously, the fiiture of at least the German-speaking 
Swis:, nurses, while on their French and Italian 
borders, too, the tide is rising which will some day 
rcudi them, within the high walls of the mountains 
of their country, and bring them into closer relations 
with the world outside. Perhaps already, in their 
deaconess orders, they have felt the influence of that 
country whieli gave i.Kistor Fliedner his first glimpse 
oi women working as in the primitive church, tc 
which we next turn, 

Holland.— About fifty years ago [wrote one of the 
lionourud pioneers of the elder and more conservative 
^Toup of educated nurses of Holland, Mej. C A. La 
li.istide Baarslag], sick nursing in Holland was chiefly the 
• ;isk of religious corporations, especially of Roman Catho- 
lic orders. The Brothers of St. Johannes de Deo have 
for more than four centuries devoted themselves to the 
care of their suffering f.'llow-members, and a great num- 
b.r of nursing sisterhoods are also of very ancient date. 
Not until the year 1830, did there arise in Protestant 
hearts the ardent desire to bring aid and comfort to their 
sick fellow-men, and the Protestant deaconesses took up 
this work oi charity. In 1843, the first house of deacoi- ■ 
esses in Holland, that at Utrecht, was opened, being in 
the- course of time followed by many other institutions of 
that kind throughout our whole country. Some of these 
draconess houses are affiliated with the Kaiserswerth 
A sociation, such as the Arnhem Home, founded in 1HS4, 
a-i 1 at present supervised by our well-known Mother Van 
Nlss. In all tliese institutions patients are nursed, pay- 
ini,' different fees according to their financial condition. 
R itles the care of such patients, the Sisters devote them- 
si'h.'cs to district nur'^ing. 
In recent years we have also developed several pnvato 

A History of Nursing 


societies for district nursing, free from any reUgious bias. 
but founded on the broad principle of human solidarity. 
Of these I will mention two, especially : that at Rotterdam 
originally established by the Dutch Protestant Society, 
but at present on a distinct basis; the Amsterdam Society 
for District Nursing,and that at The Hague.both societies 
sending out visiting nurses. The patients, who aredivided 
into different classes according to their social state pay 
for every visit at a fixed rate. The noor are aided and 
comforted by the Sisters and are free from any expense at 
all The nurse;; have a fixed salary. 

A number of institutions send out nurses for private 
duty; such are the section for nursing of the Association 
of the White Cross, the Haariem Nursing Association, 
and others. Nurses belonging -o these institutions 
receive a fixed salary (the patients' fees gonig to the 
association), but nurses preferring to work mdependently 
(the lar-est number do so) receive their own full fees 
Neariy every town in our country has its own communal 
hospital, an<l the care of the sick is becommg an ever 
greater subject of public interest. Besides these city 
hospitals, where the poor are nursed, there are a great 
many private and special ho.spitals. 

Devotion and love are indispensable quahties m a 
nurse, but they are not all. A really good nurse cannot 
dispense with knowledge; she must be trained in the art 
of nurring the sick. And in this regard we have made 
great progress in Holland during the last twenty-five 
years and more. The standard of nursing has been 
r-iised and the nurse of now-a-days is quite another being 
frnm the one of a ciuarter of a century ago. The nurse 
cf that timc--if we may call her such-was a perfect 
specimen of the Sairey Gamp type, so wonderful y im- 
„^,,rtaliscd bv Dickens. To Miss Reynvaan, late Matron 
(,{ the Wilhel.nina Hospital, a d honorary member of the 
Matrons' Council of Great B tain and Ireland, belongs 



the honour of having first brought about a thorough 
reorganisation in the nursing world. It was she who felt 
the urgent need of efficient nursing by well-bred women, 
and she herself set the example. Belonging to a patrician 
Amsterdam family, she devoted herself to nursing work. 
Her task of matron in the Buiten-Gasthuis (now the 
Wilhclmina), one of the two public hospitals of that city, 
was a difficult one, but she did not despair, and with 
the aid of Dr. Van Devcntcr, at that time medical 
superintendent, she attained her noble aim. The male 
and female Sairey Gamps were superseded by a more 
competent nursing staff. Inspired b/ her words and 
deeds a great number of well-bred and intellectually 
de\cloped women took up nursing work and gradually 
there came a blessed change in the condition of things. 
She has been a noble pioneer on the path leading to the 
elevation of nursing. The need of a special training in 
nursing was more and more clearly realised, and also the 
truth, that theoretical knowledge without practical 
experience was not enough. For this reason certain 
hospi*-als offered the opportunity for a thorough training, 
the passing of an examination, and the attainment of a 
certificate. The first certificate for nursing was given in 
1879 by the Society of the White Cross. Since that time 
the number of hospitals and societies that grant ccrtifi- 
cales has largely increased. 

We urgently want state registration and fervently hope 
that the new century will fulfil this righteous desire in a 
not too far-off future. In the meantime, the Dutch 
Association for Sick-nursing {de Nederlandschc Bond voor 
Zirkenverplc'^ins), founded in 1892, whose rules and by- 
laws have recently been re\nsed, proposes to evolve some 
order out of the present chaos, and to introduce more 
uniformity and co-operation with regard to training and 
examinations. The dilTerent hospitals and associations 
fur nursing make different demands upon the candidates 



A History of Nursing 

who arc desirous of passing c-xaminalion; a three years' 
training in one of our lar^e hospitals is generally required, 
though some of our instit\itions still think that two years 
arc sufficient. The curricuhnn, though not quite the 
Sc . everywhere, contains generally the following 
branches: Some study of ana',omy and physiology; the 
nursing of internal, infectious, and neurological diseases; 
the nursing of surgical cases, including some knowledge 
of the treatment of wounds and of first aid ; tliC care of 
lying-in-women and the new-bom; some study of hygiene, 
venrilation, feeding, disinfection, bathing, sick-room 
comfort, etc. Special certificates are given by certain 
associations for obstetrical nursing and the nur. ing of the 
insane. The probationers in the hospitals do not pay f^^r 
their training but, as a return fc^r the duties performed by 
them in the wards, they receive a small salary and their 
living expenses. In most hospitals we find, no/ to the 
medical superintendent, a Matron, who is e>;;ecially 
charged with the control of the Sisters. [In small hos- 
pitals one person sometimes comlnncs the dv.iies f 
sui)crintcndcnt and matron, as in the United State.,,] 
The foll(j\ving conclusions were accepted as principles by 
the medical sui)erintcndcnts and Matrons of our principal 
hospitals, as the result of an inquiry made in 1898. " Pa- 
tients should not be left to the care of untrained women 
either by day or night; day duty for the nurses shall not 
exceed twelve hours after deducting the time nt cdcd for 
meals ; day nurses should have an undisturi )ed night's rest 
of at least seven hours; night nurses shall pcrfonn no day 
work; everv nurse sliall have one holiday every fortnight 
and one evening (jiT duty; half an hour should be allowed 
for breakfast ami supper, and one liour for dinner; nurses 
.should have at least two weeks' holiday and hca ' nurses 
three v.-eek-,' holiday each year; hosintals .shoulc ]>ay the 
nurses' insurance fees for sickness and accident."' 
■ Trans. Int. Cong. >,i Nurses, Buffalo, 1901. 



The Bond, whose resolutions thus set for!i, 
1, ; a mixed membership. Only a small number of 
i" . members arc nurses, the lar^^e majority being 
pliysicians, directors of hospitals, and Matrons. It 
i::is also some membership among laymen, phi'an- 
thropic societies, etc.. and it publishes a journal called 
tl ■• MaandblGd voor Zickejivcrphging. Excellent as 
are, without doubt, the motives and aims of the 
nurses and Matrons on the Bond, it has not, from the 
I^oint of view of the working nurses, been an actively 
useful body. In 1910, most of the points covered in 
tlic resolutif'us just quoted are still bu"- imperfectly 
attained. Those who know how to read between 
the lines of these resolutions can readily see :hat they 
pointed to an existing order of things that was full 
of abuses. It is quite clear from them that patients 
were being nursed at night by untrained women: 
thai, day duly exceeded twelve hours, not including 
meal-times; that many were nr^t having as 
much as seven hours' sleep; tha' night nurses were 
working by day; thai nur es had practically no time 
off, no half-days, no hoHuays, nor sufficient time to 
cat their meals. Were the; things not so, there 
would hav3 been no reason for the resolutions. But 
even yet many hospitals place six-weeks* jirobationcr^ 
on night duty; hours are still too long, even though 
some improvements have been made. 

Especially is it to be noted that the Matrons, part 
of whose duty it is to look aitcr the Sisters, do not 
do so. Tlie reason they do not, is because no real 
authority i.s given them: such as they have, is merely 
delegated by the din tors, subject to immediate 
withdrawal unless the}' observe a submissive and sub- 


A History of Nursing 

ordinate attitude in all things. The mixed member- 
ship of the Bond, ihou^h it may have been planned to 
give full play and interplay to the various elements 
there represented, does not in the very least voice 
the needs and aspirations of the nurses, but only 
acts as a buffer against free expression and progress 
on their ])art. The intluence of llie hosjntal authori- 
ties predominates in the association, and even the 
Matrons have only the passive role assigned them 
of seeming to share in discussions and motions which 
nrc, in reality, settled as the financial or commercial 
or professional aspects of hospital industrialism 

The Bond has so completely dominated the situa- 
tion that, even though there is in Holland an asso- 
ciation of nursing directresses or matrons, this body 
has been singularly uninlluential in nursing matters. 
In this respect it is in striking contrast to the British 
and American societies of heads of training schools, 
which have consistently assumed a foremost place in 
voicing the professional needs of nurses and in up- 
holding their human rights. It may be said that in 
Cireat Britain and America the organised Matrons 
have always led, followed and trusted by the nurses; 
in Holland the nurses have led, while the Matrons 
have remained in the background, afraid to assert 
themselves against the hospital directors. The Bond 
is really a clearing-house where compromises made 
necessary by the 1 lusincss circumstanccsof the various 
hospitals and institutions ure agreed upon; it is not 
at all a truly educational or professional body, nor is 
it a highly ethical one. It is a characti'ristic example 
of that form of organisation that is commended and 



encourap:cd by emplnvers who are secretly unwilling 
to ijcrmil inde])endent self-governing organisation 
to arise amone wnrk;.'rs, esjiecially when the latter 
arc women, The estimate of the Bond held l)y thought- 
ful and altruistic women in the nursing jirofession 
of Holland IS indicated in the following quotation. 

The Bond was founded with tlic purpose of elevating— it tried to do this by bringing into tlic hospitals 
young women who to have some useful profession, 
and putting them into tlie places of the former attendants 
wh') had i)cen of the lowest orders of societ}-, Fu!! of 
ambition, this new element of well bred young women 
u'cnt to work, but for a great many the task soon p^roved 
I'jo heavy, for tlic directors of the hospitals, neariv all of 
whom are mem!)ersof iho Bond, d,(] not realise that it was 
impossible to let those nurses perform die same heavy 
manual labour that had formerly been done by the attend- 
ants. Some theoretical lessons were indeed given, for 
II was admitted that nursing meant something more than 
•icv.jtion and deftness, but those lessons, given at the 
end of a long, exhausting working day. wore of little prac- 
tical use. The directors did not perceive that the nurses 
nccdcHl more comfort, a better training, more spare time, 
and les,^ exhausting manual labour. Thev did not 
understand that their pupils wanted to IcHni nursing 
in the true sense of the word, that they wanted to have 
tune to solace their i)aticnts and make them comfortable. 
to -ivc them a.'l those small cares that sick persons ap- 
prmate so much. As matters stood then the best nurse 
was the one who did her manual work best. Tne direct- 
ors trained good hosj)ital attendants, but not nurses. 
_ The results were that after some years the numbers of 
desirable xoxy.y^y women ap]dying dinnnished, and such 
women sought oiher, less exhausting, occupations. They 


A History of Nursing 

saw too many nurses heini; cjuiie broken down after a few 
j-cars of hospital W(jrk or private dut_\-. Some recovered 
tlicir health af' t a long rest; others still suffer from the 
overstrain. There were then some amonj,' the nurses, 
women who ,.,ncerel\' loved their profession, who jier- 
ceived that this tendency must be checked and the state 
of things altered, if nursing was to be i)rcvcntcd from 
falling back again into the hands of uneducated and 
vulgar women, It was seen that it was high time to 
found an association to combat aiid reform many existing 
al)uses, and it was felt that it must publish its own paper 
in which to discuss ways and means of obtaining ihose 
desirable and necessary reforms. For, before igcK\ the 
editors of the Maandhlad were not inclined to allow nurses 
wh<i had an opinion of their own to have their say in that 
p;i.pcr. Xovadays, through the force of circumstances, 
matters have changed, but being in the minority in the 
meetings of the Bond, nurses have not much influence and 
dare not speak openly there. 

In Ma\-, igoo, a first meeting was held \>y some liberal- 
minded nurses and j)]iy;;icians, when the outlines and 
form of an as.sociation were decided ui)on. This associa- 
tion, now established under the name of Nosokomos, 
takes only nurses (men as well as women) into full 
mcnibers'.iip. Only nurses have a right to vote, or sit 
on the governing board. The ph\sii'ians who at first 
assisted with the work of editing our jotirnal withdrew 
when it was well under way, and it 's now edited by 

Nosokomos owes its inception and ' he marked in- 
fluence it has exerted in the norsing worM to the 
si'lenditl v.oman \vh(> .\:v . until Kjo'), its leader. 
Miss E. j. vaTi Stnikuiii began litr nursing ( atcef 
in 1S<)3, in l!u' for Chihlrcii in Hotierdain: 



ft was dunns her traininj,^ that she first realised how in- 
complete \vas the system of nursin- education, how many 
al.uses called tor reform, what an a!;solute want of sc^li'- 
danty there was amon- nurses. She felt that, as much 
m ihe interests of the patients as in that of the nurses the 
lo' cr s serx-ile attitude toward the directors of the hospital 
should change, that then- sh.xild protest openly a^ain^t 
the Ion- workm- hours, and excessive rou^h work vwl 
ahovc all, that they should be jnotected aKains't the 
U'lfair competition of those who were haillv tramed or 
even m some case., without anv training at all In iji./, 
she mamcd Dr. Alctrino, who, equally wiih herself, was 
a warm champion of justice and pro-ress. The oriKinal 
i I.iii of umtniK the nurses together in one association was 

At the first meeting on the 30th of Mav, 1900 rcarlv 
thirty responded to the summons of Mrs. Alctrino and 
t.vo of her co-workers, Miss B. van Mems and Mrs. van 
Rc.;teren Altena. It was Mrs. Aletrino's aim to arouse 
in the nurses a fcelini; of self-reliance and pride, to make 
them see that they themselves, bound close! v together 
l! id to make a .stand for their own interests— that they 
should not leave that to others. She was particularly 
w h fitted for the task she set herself. Her fine intellect, 
hroad views, warm sympathies, her willingness t(j heli)' 
hut espe<i:illy the confidence she inspired, marked her 
out as a l)orn leader and wi>e counsellor for all who came 
I" h.T for consolation and help in their troubles. Until 
I'm, her husband beiiiK Iht ever faithful c.-adjutor 
Mrs. Aletnno devoted all her time and strength to the 
a- onaiion, which, in Jum, loio, numluTcd some 700 
members. To;-ether (she first as secretary, afu-rwards 
as !>resi.lent. and he as editor-in-( hief of the Journal) 
^■■'■- '"lilt up n pouviful .self-Kovernin;: nurses' or^aima- 
' i To..,. til, r they conducted the campaign to obtain 
t'lter conditi,)ns, so it may be possible for well- 


A History of Nursing 

educated women to choose nursinfj as a profession, 
without fearing to have their health, if not irreparably 
injured, at least perhaps seriou: ly impaired after a few 
years' service. It is mainly owin^' to their intelli^'cnt 
k-adurship and immunsc working power that many 
abuses have now disappeared, and that great questions, 
such as uniform training, preparatory teaching, state 
cxaiHination, etc., are being considered, not only in the 
small nursing world, but also in the wider one of the 
general pub'ic 

Another woman of unusual gifts of discernment 
and devuiicm gave herself to the cause of advancing 
the educational and ethical status of nurses, namely, J. C. Van Lanschot Ilubrecht, for a long time 
the secretary of the association. She iiad begun her 
nursing career in 1890, in the Hospital for Children in 
Amsterdam. After some three years there, she had 
a serious breakdown, and afterwards was only able to 
do private duty for .diort periods at a time. Coming 
back to Amsterdam to live, in i<)04, she was elected 
a member of tb.e executive bnard of .\osi'<komos, and 
became secretary in J 905. She soon formed a warm 
friendsliip with Mrs. Aletrino ard her husband, and 
under their stimulating inllucnce gave herself wholly, 
with deej) enthusiasm, to the work of the association, 
r-ceing in it a part of the great cause of human pro- 
jjress through uplili of the workers and esiiccially I'l 
\\(Mneii. Tbev met the usual obstacles. 

Duruig t'u' ixistiiicc of Nosokomos [wroi" Miss Hub- 
rechtj, we have had many dinicullirs and cii'-ount tiJ 
much opposition fruni physicians and hospital directors, 
some of whom havi' forbiddi'U tlie mir cs on their staffs to 

' Britiih Juurnal uj Sutitn^, Ucl. -'((, 11)07, .hkI otht"' sources. 



hccomc members of the association. They do not allow 
their nurses independent action or the rij,'ht to take 
care of their own int.Tests. Every improvement must 
..e a^favour from the director, to be obtained by a very 
humlile reque.sL. AlthouKh improvements in the phvsiral 
conditions of hospitals took place, the deficiencies in 
careful trainm^ persisted, and were the more evident as 
medicine Ijy no means stood still, but advanced with a 
rapi.liiy unequalled at any former time of the present 

r Hubreclit points out the strange inconsist- 
ency of hospital directors in the following description : 

The probationer is not considered as a student to be 
tau-ht . . . she only learns how to do the hospital work- 
she is not taught the full extent of her callin*,': . . . yit 
tin- di.)loma certifies her as capable of nursin- all casci 
aad aflirms her competency as a good nurse. lUit, when 
shr seeks a permanent position, she meets a strange and 
uiuxpected rebuff; the same authorities who graduated 
h( r may now answer inquiries about her bv statements 
quite ar variance with the text of her certiiicate, and she 
may h arn that zhv iias not the knowledge necessary for 
♦he .vork wliich she solicits. The explanation of thLs 
ndule IS simple. . . . These diplomas, which should be 
t'Mimonials of capacity, are distributed with incredible 
cirelcssness. !• vcTy hospital may ar-o^ate to itself the 
riKl.t to give dii)lomas and badges. Women, ba.iiy 
tr.nned or not at all. take advantage of ih,s .onfusion. 
■ . . SoTne months ag.). the /inml passed a deplorably 
reactionary mea.sure proviilmg that it nei'd no longer be 
necessary to spc^nd three years in a genend h.,spiial of 
"•>i Ir- -iKui forty, hut that a romnutt.v appointed 
bv the Hotni sl,ali be competent to decide whether this 
' tiiat special ho.-.pital, (<r such and such a mall one 

VOL. IV.— J • 


A History of Nursing 

may be rc^'arded as a training school, the decision to ba 
arrived at l)y the whole number of days spent by patients 
in the little [jlace, and the variety nf diseases admitted. 
Thus at one stroke the whcjle principle of a general hos- 
]nVd\ t'^aining is swepi .iway. The reasun of I'nis deplor- 
able decision is not far to seek. It is >imi)ly t;.,it one 
must defer to the managers of the small nosjjit.i' , who by 
this arrangement are able to secure the necc. ry per- 
sonnel most cheai)ly. ..." 

I have spoken of our lack of systematic instruction; 
whose fault is this? Primarily it is that of the Matrons, 
and next that of the nurses themselves, who, too c: ten 
indifferent and apathetic, lacking in social sentin nt and 
solidarity, submit to this state of things, . . . Our 
Holland Matrons have an association, ut it is not 
active, nor docs it take part in the solution of ' airnrng 
questions; its members do not seem to realise that it is 
their part to put themselves at the head of the reform 
movement and by their words and acts point out the 
way to elevate and advance the profc^ssion. 

Yet the demands made by Nosokomos u-ere and are 
very reasonable. It wants a better and more thomugh 
training; a more practical distribution of the hours for 
work and study; shorter hours of wcjrk; statt' rt-gulation 
of training sehools, with examination. N^'sokonuis wants 
the nurses to be independent of all philanthropic aid; 
to maki,' it jiossible for them to take care of themselves 
in illness, aceiilnit. and old age; i' wants luirses to be 
really fitii il for their work bv improving their comlitions 
of lif" and by giving them a thorough preparation for it. 

The strife the voung association had to carry on from 
the outset did not harm it. It madi^ it strong and self- 
reliant, "-d that those yirogr(>ssive physicians who, in the 
beginning, had heljiei) with its alT.n'r. have now wiili- 
drawn. This struggle has also brought to light many 

* Rrporti. Conference of Nurses, Pari.s, 1907. 



al.uscs, which hav. been rectified after being published 
and discu.sed. Now that it has attained a secure 
l--.sition. it>, aim is to work mo-e faithfully than ever f„r 
the attamincnt of our idc.-.s. We wish to make ihe 
nurse, by her knowledge and experience, her devoti.m 
and tact, a real help to the physician; one to whom he 
can entrust nis patient with the fullest feeling of securiLy 
Ue wish to develop in nurses those qualities which will 
nuike them real at the bedsi.k not only 
becau ..of their sympathy, but because of the broad and 
thorough training which makes them a real support to 
patient and family. vVe wish to have spe- lal curses for 
ipenntendents, matrons, district and i)rivate nurses 
perfect them in the careers they may desire to follow 
^"'.'r I her three years of training. We wish the training 
and examination t<, be regulated by law. with the view of 
ol'Ja.rnng more uniformity. Now every husi.ital can 
K'^^- Its nurses what training it chooses. We wish also 
•- I'avc. opportunities for experience in all the lines of 
-sonal and preventive uork which will soon be as much 
the nurses' sphere as actual nursing is at ,,resent The 
f^reat ment of No:;okomns lies in the influ-nce it has had 
on ali matters rclativ. to the education of nurses and ihe 
conaitions under which they work. Through its exer- 
tions, us bold an.l op,-! .li.scussion of all and 
."•mttng to the way of reformation, much imi,rovement 
lias come ab(jut. 

.\osoko,ros was indeed a militant puDlic.tion 
;'r years. It tearles,siy attacked every stronKhold 
"• lH)urr and rriviloge as related to the world 
ar-.d w..rk of nursing. It st<.< ! with the Brilisk 
J-:>n,al of Nursing an<l /.; Cardc-Malnde IIos- 
P'tnlihr m its sc.If-imposed mission of combat 
against the mercenary and nndemociatic order 


A History of Nursing 

which retarded the advance of women workers. It 
never allowed an issue to pass ; it never ovirkoked 
a detail; week by week local and national issues were 
held up for scrutiny and criticism. It sometimes 
seemed, to foreign observers, as if its pugnacity must 
antagonise those who might otherwise be friends, 
but this surmise was baseless, for no amount of soft 
speaking would have been of use, as Dr. and Mrs. 
Alctrino well knew. 

The steps taken by the Holland association toward 
state registration have been recorded for us in 
chronological order by Aliss Hubrecht. 

In September, 1907, the executive committee of 
Nosokomos .sent in a petition to the government asking 
for state rej^istration. Our reasons were .set forth in full, 
as i)ublishcd in the British Journal of i\ursi>v^, March 14 
and 28, 1908, In December, 1907. a second petition was 
sent, this time addressed to the second chamber of the 
House of Parliament, with the view of ex})laining still 
more fully, and with many ilhistrations, why state regis- 
tration is urgently neediMJ. Tlie government sent out 
documents to the Central Health Department asking 
for adviee. This board resolved to institute an inq' iry 
as to the training of nurses in hos[)itals and asylums. A 
very extensive i/tirslidiuiairc was made up, bearing upon 
preliminary tniimng, the number of probationers and 
certilp'd luirses in every '""ospital and asylum, the working 
hours, '-Le. 

Mrs. Alctrino was called upon for information in 
this incjuiry, but, u]) to the end of i()i(). the Dc 

])artniciU <»f llcahii tuithcr published tlie results of 
its mvc: '•_';' .on nor gav its tipinion upon state 



In February, 1909, Nosokomos published in pampniet 
form the two addresses which it had made in 1907 to the 
n;()vcmment, and sent a copy to every physician in 
Il'illand, enclosing a fjost-card and asking for an expres- 
sion of opinion as to the desirabihty of state registration 
for nurses. The result was on the whole very gratifying ; 
one-fourth of all the medical men of Holland declared 
themselves in favour of it. Only ninety-one went on 
record as opposed, while the others did not answer at all. 
In April, 1909, the Association of Medical Superintend- 
ents of Hospitals and Asylums sent an address to the 
government protesting against state registration, on 
the plea that it was not necessary, and was not even 
desired. The arguments were the same as everywhere 
else : that nursing is a work of lo\e and devotion for which 
no fixed rules can be made; that character cannot be 
registered; that the present state of affairs is satisfactory 
and matters constantly improving under private initia- 
tive, etc. This association had, in 1901, declaed state 
registration to be urgently needed; but now, "or some 
un'aiown reason, they had changed their minds. In 
September, 1909, 'hree petitions ^vcre sent in, all -n 
favour of state registration: one by the Roman Cath- 
olic Association for the Promotion of \ursing, one by 
Nosokomos, and one by the League of Male \urses. 

During this campaign a number of pamphlets 
wore written, and Miss Hubrecht published a book 
dealing with ♦^he whole subject. 

T!ie outloc/v at time of writing was not very hope- 
tul. The conservative, calvinistic ministry of 191 j 
was not favourable to state registration. The boards 
of the deaconess associations and other groups of 
rehgious nursing orders, influence with the 
present government is strong, were absolutely opposed 


A History of Nursing 

to it. With them the idea prevails that nurses should 
not be eeonomieally independent women, eontrolHng 
their own lives, but must live together as one flock 
with a shepherd. Though trained, they receive no 
certificates, bv-mg thus kept in more complete 
dependence upon their Motherhouses. 

Another group in op})osition has been spoken of, 
namely, the hospital and asylum superintendents. 
They do not relish the idea of state control and state 
intervention in their ways of managing their insti- 
tutions and the training of their nurses. 

Another difficulty in the realisation of our wishes is the 
fact thai nursini^ is, as yet, hardly held to be a profession. 
The individual nurse will, in most cases, meet with con- 
sideration and a courteous demeanour from the j)hysician, 
but as a grouj) of persons, as a class, they are still lar<;cly 
regarded and given much the same place as the servant- 
attendants of fcjrmer times. The doctors see in the 
nurses not their assistants and equals, but their inferiors. 
I am of the oi)inion that for this reason many physicians 
oppose state registration. We say it will elevate the 
profession; : any of them do not wish it to be elevated. 

I am convmced that there is a deep-lying connection 
between the economic dependence of women and the 
lack of consideration that nursing, as a profession, 
receives,- the unsatisfactory conditions under nhich we, 
as nurses, are living. Oar nurses, even more than other 
women, are, by reason of their isolated livcn,, inclined to 
submissivencss, and to an apathe ic acceptance ot bad 
conditions. They are not conscious of st/iidarity; they 
do not undiTStaiid the meaning of that word. They do 
not realise the gro.-.t social strength of unity; they do not 
seek in co-operation the means to alt'T ; ims'^nt condition".. 
They still harbour tiie mistaken and unwhole.some idea 


that a <;ood nurse should sacrifice her life, as do 


the nuns 

aii.i .ieaconcsscs, forKcttin- tlial I he nuns and deaconesses 
arc lakcn care oi throuK^houL Uirir whole lives, and thai doctrine of work done from motives of love only is 
a sham, since they -et their payment in the form of 
I".I,;inK. clothinj:, food, and care m sickness and old age: 
-tor^'ettm-, loo, that the woman whose life is well 
poised, who Knves freely of her love and strength to her 
f.IIow-crcatures— to society— but without squandering 
her vigour, i.s more useful than the woman who exhausts 
her forces in a few years, only to become a burden for the 
rr^t of her life. ... In conclusion, we want to point 
out that, whereas the nursing i)rofession is not, as the 
nie.hcal profession, under state control, many persons, 
especially in the large towns, often use the nurses' uni-' 
form for immoral purposes. Thcv are altematel- nurse 
and prostitute, hence the terril)le risk of infecting their 
patients with their own infectious diseases, to sav nothing 
of the damcge done to the good name of the profession 

For the nurses who do not belong to anv rcligiou.s 
association, the working hours are also verv 'long; they 
iive out of the world; notliing is done to awaken' their 
iiiierest beyond nursing; no provision is made for them 
in time of illness or old age. 

The nurses' question is inherent in the whole woman's 
q'K'stion, but as long as they hold aloof on the pretence 
that the very ..naracter of their work forbids tlu>m to act 
as other women and ol)ligcs them to .sacrifice all rightful 
Haims, it, will be diHlcuIt to obtain any improvements. 
Only political and economic enfranchisement can be the 
1. ver to arouse them:-to make them realise how much 
hroader and nobler their life can be, once out of 'he 
narrow groove in which it is at present run^in-^. 

At last, in i()ii, the sj 

' l^ctttr from Miss Huhr.'.ht to 

)ec'a: committee appointed 

' cuitor. 



A History of Nursing 

by the Board of Health from its members, in response 
to the request of XosoL-onios, made its report. Three 
and a half years had ^oiie by, and the nurses suspected 
that the task had been an uncongenial one. The 
report was negative and lukewarm. 


The committee bc^'an its work by instituting an 
inquiry as to the conditions in the hospitals and training 
schools in regard to working hours, preliminary teaching, 
training and examinations, sending out a long qucstior- 
naire to ... a!' hospitals, asylums, and nursing homes 
in the country. 

In this way much valuable information was gathered. 
In the report the committee first gives its opinion on the 
most important questions pertaining to nursing educa- 
tion, and concludes witli expressing some advice as to 
necessary reforms. But this advice is very disappoint- 
ing. It is true that the desirability of some control of 
the examinations is advised, that certain gaps in the 
training are admitted, and that the wish to remedy these 
is expressed, but all is done in such a hesitating way, and 
is interspersed with so nuich flattery for the Neder- 
landsche Bond voor Zivkcmerplcging, that ... it is 
most difficult to know the real opinion of the committee, 
for every time it points out some fault, or proposes some 
improvement, it recedes quickly, as if saying, "tout est 
pour Ic mieux dans le mcilleur dcs mondcs." . . . 

It was a great disapi)ointment to perceive that the 
committee took sides with the medical suiierintendents 
and Matrons, and considered the matter from the point 
of view of what kind of training is necessary for hospital 
service, instead of takinj^ the broader view. The inquiry 
proved: (i) That a pri'liminary training is given hardly 
anvwherc; (2) that there is no vmiformity in the condi- 
tions of admission of i)robat'oners to the training schools; 



(3) that there is no uniformity in training; (4) that t!)cre 
is no uniformity in the examinations. 

Of course, all hospitals insist on good health an<l ^.Qod 
morals as the first condition for admission to their train- 
in,,' schools. As to previous education, some hosjiitals 
de>ire the certificate of a hi-her school; most think the 
instruction given at a primary school sullicient, and a 
feu- do not even ask as much as that. To an von e 
knowing that in Holland children leave the primary 
school in their twelfth year, it is evident that the com- 
mittee has made a great mistake in declaring that the 
priMiary standard of education is sulTlcient for a nurse. 
It <hows so cleariy in what a low estimate nursing is held 
by the authorities— how it is in their eyes no more than 
an mdustry which any uneducated :)erson can exercise 

The inquiry brought to light the sad lack of uniformity 
in the practical training; every hospital has its own views 
upon the matter and acts accordingly, no matter whetlier 
that traming is sufficient to fit the nurse for her future 
career or not. 

... The committee is of the opinion that the present 
training is sufficient; that there is no need of a state 
certificate to protect the profession ... it thinks that 
tne presence of a deputy of the government at examina- 
tions will mend all matters. 

The committee suggests a few improvements in regard 
to nta-ses' homes, salaries, and long working hours IBut 
in all these matters, the fact that any improvement will 
cost much money is put forward so strongly that wo 
shall not be surprised if the Minister receives the impres- 
sion that the matter is too unimj-ortant to spend money 
on. . . . "Shorter working hours" is at this moment a 
burning question in our nursing worid. One of our 
unucrsity professors made a speech on the subject 
w.iuh roused much indignation among the nurses. The 
t' t of it was that hours are not too long. Probationers 












1.4 1 




A History of Xursing 

must realise that ihcy can onh- earn tlieir profession 
by \vorkin<; for l^nv^ hours, whii ii is synonymous with 
long (lays in which to learn. 1"lu'y can only show tlieir 
love of and devotion to nursing' by working long and 
hard. It is true that many of them are overtireil and 
look ill; but there the parents who allo^ved them to 
become probaiioners are at fault. Is not that excellent 


Our Matrons' Council adopted some resolutions at its 
general meeting last spring, where the same things were 

And then seeing those young women who are the 
victims of such narrow reasoning, one feels sad. All 
nursing work seems so useless when, in nursing patients 
back to health, tlie nursi-s become jiatients in their turn. 
What prolit i, that to society^' 

As we write, nursing education in Holland seems 
to be stationary, but the nurses are strengtlienir.g 
their organi<;ation. Miss Ilubrecht, president of 
Nosokomos for 19 1 2, has succeeded in bringing the 
society to oi)en headquarters and unite all its work 
uiuler an office secretary, and lias further founded 
a large and active Society for State Registration, 
composed of laymen and jiroft-dor.als. Finally, 
the leading nurses are supporting the woman suf 
fruge movement as fundamental to changed condi- 
tions of education or of work for women. 

Belgium. In 1909, for the first time, a general out- 
line of modern nursing conditions in Belgium was 
heard 1)_\' nurses fioin other countiie , to whom tlie 
Belgian nursing field li;id lucn, before, almost un- 
knowTi terriioiA-. It was read I>y Miss ("avell, wlui 

^ Britiih Juurnal uj .\untng,, Sipt. i, I'jii, \>. 195- 



was herself the Enghsli Alalron she nienlions, and 
r.:n as follows; 

^ XursiiiK in Belgium, though still much behind that of 
Ka-Iand, Holland, and other countries, has made some 
progress in the last two or three years. A desire is e\-i- 
li.'iit in many quarters to supersede the present ignorant 
and blundering methods by enlightened and up-to-date 
work. The first attempt to alter the existing state of 
things was made by Dr. Deijolpe, who instituted lectures 
for lay nurses twenty years ago. Thc> were given twice 
n^ week, and included a few i)ractical demonstrations. 
The jjupils were not attached to a hosi)ital, and they had, 
and have, no actual practical work. The school is still 
can-ice] ,,n under tlie .same conditions, directed by Alme. 

The hospitals in Belgium arc staffed by nuns or by lay 
nursis, the greater part of whom are peasants taken 
ihreetiy from the fields, without any trainin.g or instruc- 
tion. WIktc the nuns are in charge, nnich of tiie rou-h 
and un!)leasant work is don(> by lay nurses, who .are no 
better than low-class servants An attempt has bem 
made at the Ilopital St. Jian to fimn a regular training 
school. .\l fir.t tiic fiw i)rol)ationers n'cruited were 
instruct.,.! I'ntin'ly by doctors. After a time the n. .d 
ef a traine<] .Matron was hit, and one was pla<cd at the 
head. Uiifortunaicly, t'le difficulties put in her way 
were many, and I believe the .school is .d presmt almost 

A mental hospital cxi„ts near Brussels, at the Fort 
Jaco at Ucclc. where about forty jiupils, mostly nut( h 
Women, are trained under the alilr direction of Dr. L. y 
and a Dutch Sister. The probationers reaivr li. tuns 
in the usual subjects, and also some general in -irm-tion 
jn other branches bearing on their work. They pass 


A History of Nursing 

examinations and receive certificates, including; one for 
mental work. All the pupils are resident within the 
school, a condition unfortunately not ^'cneral in the 

The only school which exactly answers to the condi- 
tions of traininj^ in England is the Ecole Beige d'lnfirm- 
i^res Diplomee.s generally known as the School of the 
Rue de la Culture. This school has been open since 
October i, 1907, and has now [l9'>9] thirteen pujiil^. 
It was founded by a committee of doctors and others 
anxious to improve nursing, to open a new career to 
Belgian girls of go^d education, aiid to train new aids 
in the cause of science. An English Matron was engaged 
to open it, and four pupils formed the first recruits. After 
two months' trial, the probationers sign a contract for 
five years. The first year is passed in a clinic attached 
to the school, where medical cases are received and 
lectures given; the second in a surgical clinic, where the 
lectures are continued; m the third we hope to give the 
pupils experience in infectious work or in the nursing of 
children. A great point is made of discipline and 
character, and the pupils have given proof of much 
devotion and loyalty. 

At Antwerp a certain number of pupils are received 
at the hosjjital under the direction of Dr. Sano. They 
are not obliged to live in the hospital, and they have no 
Matron. Lectures are given each evening, and examina- 
tions are held for the diploma. Liege, Gand, and Andcr- 
16che are also anxious to estabhsh training schools, niid 
there is one at Mons which at present is not definitely 

In 1908. state registration was inaugurated, and a 
certificate is now given to all men and women who ]) 
the government ( xamination. This certificate can be 
gaint-d by following cert;iin lectures during one year- 
practical work is not obligatory. An examination is also 



hi'IJ for a diploma in mental nursinj,'. The state cer- 
tificate shows the erroneous ideas of nursing held in our 
country. The conditions for obtaining' it will have to be 
much altered as the work advances. ' 

The government examination, elementary 
as it is, demonstrates tlie modern tendency in nursing, 
was brought about by royal ediet, this, in turn, being 
the result of agitation and resolutions of the medical 
societies. Nurses seem to have had little or no 
share in obtaining their legal status. The standards 
TLvngnised are: {a) a tv/o years' eourse in public or 
I)ri\ate hospital; [h) one year's theoretical and 
practical work given by physicians on the subjects 
specified for examination, viz.: anatomy and physi- 
elogy, asepsis and antisepsis, medical nursing, record 
k'cping, and emergencies. Api)licants must be eight- 
cm years old and of good moral character. The 
examinations are conducted by physicians. Yet, 
elementary though it be, the Belgian state registra- 
tion has already had a salutary effect in stimulating 
t naming elTorts. The religious nursing orders have 
accejucd it, and not only that, have criticised its 
inadcciuaey in not emphasising i)ractical hospital 
drill, while a central school to ]>rovide a uniform 
i>tandard of teaching for the Sisters of the reli-ious 
nnrsing orders was begun very soon after the pro- 
mulgation of the edict, with results that are very 
gratifying to the friends of the movement. 

The training sc1kx)1 spoken of by Miss Cavcll as 
Ix-ing undertaken at the Ilnjutal St. Jean stniggled 
through its dilfieulties so far as to have an oOicial 

' Intermit ional Congress of Nurses. L<jnU<.(i, lyin;, R, ports. 


A History of Nursing 

ceremonial of inauguration in 191 1, in the beautiful 
Hotel de Ville. The school is under the control of the 
city administration, and bright hopes for its future 
now seem justified. The Nurses' Home is in the 
Rue Pacheco, and accommodates twenty or more 
pujuls, who receive their practical training in the 
historic and picturesque hospital of St. John, or in 
certain of its divisions. 

The school directed by Miss Cavell is well past 
the experimental stage. In 19 12 it had thirty-two 
pupils, who were in training in four different hos- 
pitals, in each one of which the school placed a 
tra.ned Directrice, on the English system, while 
every ward has a trained head nurse. 

Belgium shows a great awakening in nursing in- 
terests, and progress is under way. Many physicians 
hold liberal opinions, even upon that crux of dis- 
cussion, the Matron's position. Antwerp has a 
munici])al school, and there is a Belgian Society to 
Develop Training Schools for Nurses. 




Italy.-Xowhere on the continent, except in 
iranoe. are there such old and interesting hos- 
I-als as ,n Italy. Judged by thc.r architectural 
a">l artistic charms, and by the atmosphere of 
;'"'-iuity and story in which they are enveloped. 
;1 ey are tascinating, but in the light of modern ideas 
al. tar in,o the background. In 1903. an American 
', seeing them for the first time, thus described 
IKT im])ressions: 

In K'.inK through these hospitals one cannot but feci 
mrvwhcTc the entire absence of real nursing, no matter 
how charnnng the picturesque side may b..' Sc, long L 
the patients are not .seriously ill. it ,s not .so bad. but 

case r T.,'"' •''''• ^^"— -•^- and other acute 
ca then all the,uacy of the care strikes one. 
^rom the nursing standpoint, th. worst were the great 
Gc'nvral Hospual at ^bIan and thnv „f Ui. lar,. n 
Rome. Everything looked.....s,f,,^ 

^nso work p,K-., ahend which w..uld never be. caught 
UI uuh. 1 ,.. nuns m the... :;i,an,u. hospitals are worn 
'"Tl haggard, and one cannot .i,,„bt th:,f ih.v -ir,. all 
overtaxed, even though nothing- is phmhtIv dono ' ' 


A History of Nursing 

The system of nursing that had developed during 
the Middle Ages, producing saints and humble, sclf- 
sacrihcing workers whose names and very memories 
are now lost, has come down to the present day un- 
changed in general outline, but altered for the 
worse in certain details, namely, the diminished 
numbers of nuns and the introduction of secular 
unlramed attendants under ihe authority of the civil 

In a word, the transition stage that marked the 
last century in French hos]Mtals had been entered 
upon, somewhat later, by those of Italy. Through 
the pressure of economic conditions the numbers 
of oblates, lay Sisters, and other unpaid workers 
were shrinking, and those of self-support mg though 
ever so poorly paid women, increasing. This eco- 
nomic transformation; political changes, bringing 
tfic civil government more to the front in hospital 
management and displacing the purely clerical con- 
trol; scientific advance, revolutionising the study 
and practice oi medicine and profoundly altering the 
relation of the nuns to hospital work, v.-ere the three 
deep-lying factors prei)aring the way for the indi- 
vidual workers v, hose careers we are about to follow. 
But before beginning with the doings of the new gen- 
eration, we shall quote from an article written by a 
nurse m Italy, which gives an authoritative state- 
ment of the internal conditions of the hospitals, and 
sets the stage, as it were, for our characters. 

The writer, Anna Celli, has been briefly referred 

to in an earlier chapter.' She was of German birth 

•anil had been trained as a nurse in the large hospital 

' .1 Hiilory oj Sursing, Vol. I., p. 5I,V 



at Eppendorf. As Sister Anna Fraentzel she was 
wx'll known in Germany. Her marriage to Professor 
An; rio Celli, famous among physicians for his re- 
search work into, and practical experiments with, ma- 
laria, ga\e a new direction to, but did not abate, her 
professional ardour. Beautiful and accomplished, 
she threw herself with intensity of temperament 
into the problems about her. She and T/ofessor 
C\]li arc both Socialists, and engrossed in social uj,'- 
lif:. As Socialist member of the Italian Parliament, 
Professor Celli helped to bring about the government 
control of quinine, while Signora Celli visited the 
peasants of large regions, making control experiments, 
taking blood specimens, and in every way assisting 
hor husband. She opened and was rcsj.onsible for 
a dispensary for children in one of the poorest parts 
of Rome. She worked there ])art of every day, and 
maintained cots for children who needed to remain 
for some little time. She made strenuous efforts to 
initiate the training of nurses, and succeeded in de- 
veloping certain hues of teaching, though without 
f-iuiding a regular school. Ilcr greatest contribu- 
iion to nursing reform in Italy was. undoubtedl}', 
her strong, accurate published presentation of careful,' 
thorough investigations into conditions, and her 
bold statement of facts. Her writings are charac- 
terised by high professional ideals and warm human 

The -servant nurses are the onlv ones w ;io reallv atU'nd 
to the sick. Frw in.kvd are ilu- hospitals wJu iv th.. i- 
done by the Si.ters, as, for example, to a certain extent 
in Rome at the San Giovanni, at th,. r,>ttnl,.r,,ro 

iwL. IV. — 



. >.< 



A History of Nursing 

in Turin, the civil hospital at Udine, etc. ^ Still fewer 
are the examples, as at Pavia and in S. Maria Xuova in 
Florence, where semi-reliKious orders of women who have 
taken no re-;ular vows are in charge of the wards an.l 
perform all the most delicate and imi^ortant duties for 
the sick. . . . The discipline of the reli^aous orders is 
eertainly vastly superior to that of the lay nurses, and this 
is of the greatest importance for those attending upon 
the sick. But the admirable discipHne of the Catholic 
Church has this one defect : instead of first recognisinK_the 
medical, it puts first the religious authority. This is a 
stumbling block. The service of the sick is looked upcui 
as a labour rewarded in heaven, and it is not considered 
neccssarv to teach it as a profession. It is regarded as a 
religious' function. It has happened that Sisters have 
dechned to carry out medical orders for children, saying 
that "it was better they should become angels. " In one 
instance, a patient having hemorrhage, instead of calling 
the physician the Sister went for the priest. Another 
allowed a patient \\ith pneumonia to get up on a winter 
night to pray on the cold floor, where, ^.alf-dying, he 
was found by the doctor. 

This is not said in a critical spirit, for I am the first 
to recognise the great merits of the Sisters. But 
science is to-day too far advanced for this to be de- 
sirable, and to be a competent nurse it is absolutely 
necessary that the nurse be thoroughly taught, and 
not limited to the religious service. She sl'uuld oc- 
cupy herself solely ^vith the sick and leaxe all else to 
others. She should be exclusively subordinate to the 
medical ofllcers and follow rigorously all their orders 
She should be put through a practical and theoretical 
course, and be capable not only of recognising grave 
symptoms, bat also, in times of emergency, of applying 
*v... =...„...,)..- Ai-1 Iv.fore oractising she should be well 
initruct oh' partly by the physicians and surgeons, and 



partly by the trained and qualified head of nurses. She 
should not, from reasons of false modesty, leave the most 
important jiarts of the care of the sick to attendants, but 
it should be her hij^diest duty and honour to have no 
i,;;noraiit jjcrson touch her patient. She should not wear 
a liark habit and immense headdress which impedes 
work and becomes a vehicle for micro-organisms, but 
choose a light, washable dress. Until such riforms can 
Ik made the religious Sister can never be a model nurse 
in the modern sense of the word. . . . 

To-day, the care of the sick in Italy is largely in the 
hantls of illiterate lay persons, engaged as servants. In 
f;eneral they are admitted from the age of eighteen to 
that of forty years, in one hospital at fifteen," in another 
at sixteen. In another there is no rule. Usually only 
unmarried women arc accepted, because the work 
rctjuircs that they should live in the hospital. However, 
in a number of institutions this rule is not in force. In 
tv.o the applicant must siJcnd six months in the laundry 
bi'fore being engaged as a nurse. In others she is 
engaged without condition. In five she must give some 
unpaid time — in one, two months, in another, three, in 
another, two years, before being definitely accepted. 
In lino it is compulsory to attend lectures, in another it is 
Voluntary. In some hospitals practical instruction is 
^'iven, in others, both practical and theoretical, with an 
examination at the end. At Pavia a ])hysician gives a 
course of two months' teaching after the nurses demon- 
strate that they can read, write, and do simple arith- 
•" 'ic. At Ferrara a similar course lasts four months, 
- ■ :i one lesson a week, and com])rises medical and surgi- 
cal work. At Siena physicians give a theoretical course 
' ' -ix months. If the ai)])licants, men or women, cannot 
■^''vn a satisfactory examination, they are not 

' In the orij^inal article, Signora Colli gives the names vi all hospi- 
tals in t'ull. 



A History of Nursing 

accepted. In Florence, every yoar, the physicians and 
surgeons give a practical and llicorctical course of six 
months, and this, as at Rome, may be attended by 

These courses appear well on paper (and they do indeed 
represent a step in advance), but in reality they olten do 
more harm than good. Instead of being of practical 
benefit, they only serve to confuse the minds of the pupils. 
The instructor should be able to descend to the level of 
his hearers, so as to explain things in a way they can 
understand. It is most difficult for young persons who 
have hardly gone through the elementary schools to 
understand any part of so complicated an organism as 
the body. Instead of being made to memorise 
the ;-,keleton and its parts, would it not be better for the 
nurse to understand the daily functions of the body? 
So it happens that, whether the course is taken or not, 
the ignorance of the pupils remains the same. Especially, 
even when the course is taken, they have no idea of 
asepsis and antiscpsi:^, of diet for various maladies, of 
how to apply treatment, and so on. Who ever teaches 
them their duties toward the sick? Who shows them 
how to make a patient comfortable? Who drills them 
in the cleanliness so essential in a ward or sick-room? 
Who teaches many other necessary little points? The 
physician cannot do so; often he does not know how him- 
self. No one can do this but a woman, and therefore the 
pupils must have head nurses who can teach them. 

After having passed the requirements of the different 
hospitals, they arc taken into service under varying 
conditions. . . . Few hospitals make any provision for 
the old age of their employees; in others they are dis- 
missed when no longer capable. As a result of insuf- 
ficient pay the nurses demand fees, and have a marvellous 
r,rt in rxtr.nrtinfT sonicthine, even from the poorest. The 
relatives of the sick ones, hoping to secure better treat- 



mcnt for them, often give beyond their means. I do not 
know whether any hosi)itals forbid taking fees, but th. "c 
ar<; certainly some where the authorities count upon them 
in paying smaller wages. Then, too, this meagre payment 
often drives the nurses into immoral or illicit ways of 
making money. In general, nurses have the daily care 
of from eiglit to fifteen patients, and twice as many by 
i.i-lu, hut there are hospitals where one nurse may hvve 
thirty and more to attend to. 

Tuscany is undoubtedly the most advanced part of 
Italy in regard to hospital service. vSiena and Florence 
especially have excellent rules. The work of the nunses 
tl-KTc is well regulated and their future is provided for. 
< hi the other hand, in such centres as Tiirin, Milan, Rome, 
Naples, the service leaves much to be desired. Shameful 
conditi(jns are found in one of the Neapolitan hospitals, 
wlicre the i)atients one another. When will these 
n^vcs.sary reforms in the service be made? It is a ques- 
tion of the highest importance for the whole people. 
The service in private duty is even worse than in hospi- 
tals and calls insistently for improvement.' 

Signora Celli concluded her paper by presenting a 
table of figures which she had personally obtained, 
showing the hours of work, amount of vrages, and 
standards of food and housing of the nurses. For 
reasons of s|)ace we omit this table. The d,.ta as to 
hours of work have been summarised in an earlier 
volume. ' It is enough, now, to say that they ranged 
from twelve to forty-eight hours of continuous work. 
Hie obstacles, then, to a modem system of nursing 
for Italy were weighty. With mediaeval standards of 

■ " La Donna Infermiera, " by Anna Celli ; Umone Fcmminile, Nos. 
••in<l ^. 4. 7. and 8. igoi, 
M History of Nursing, Vol. I., p. 514. 


A Ilistorv of Nursing 

technique and nursiny, hospitals were stafled by 
cheap labour, for even the nuns belonj^ed in this class, 
5,ince ihey were supported by t heir orders, which were 
paid r.iost meagrely by the administration for their 
services. The more technical and responsible parts 
of nursing care were ])erformed by medical students 
and young physician.;, who, in the hospitals, took 
thic ])laces of our senior nurses, and, in jjrivate duty, 
wen; uMUilly called to be on hand in the houses of the 
wealthy while a nun watched the patient. ' Religious 
sentiment, administrative eonservatism, professional 
caution, social usage, xigid conventions, medical 
jealousy, and economic bondage ofTered formid- 
able barriers to a modern invasion of the antiquated 
nursing service ot ital_. 

Twenty-five years ago no iniluence from without 
had ruffled the order of the internal management of 
the Italian hospitals. Rut it was meant to be the 
prerogative of Old England here, as in many other 
countries, to bring a new element into these massive 
buildings. Tlie lo .e of English people for Italy is 
proverbial. The Italian cities liave always held colo- 
nies of Britons, and it so happened that in Florence. 
ill iS() , there lived a Scotch- E.nglish lady with her 
family. A born altruist is Miss Amy Turton, j.os- 
sessing extraordinary optimism and energy, with a 

' Fur private duty there were the Dau^ililcrs of St. Anna, with ii-s 
house in Siena. Each Sister takes the name of Anna. For dislrut 
nursing there were the Sisters of the Sacre.l Hearts of Jesus unl 
Mary, a new order. An English private duty order working m 
Rome was the Little Company of Mary. These Sisters. thouRh 
doing private duty intirely, do not make any charge, but leave it t - 
the patients to give what they will. They are very efTieient nurs. 
and do not practise fasts or austerities, regarding the difficulties i 
the calling as their e(iuivaleni. 



> I '■:;!■ '11, ;iA I'l. .iu> 1 ..! M... i. ih .\ui-iiii; III ll.ily 

Cir.iri' Max!' I 
Sujuris-.titiiU-!;!, U!'.!f ' 



gift for setting things in motion that has had notable 
results in many directioitr.. Xo one else eould so well 
as she describe her long, plucky, undiscouraged 
quest during the years when, like Columbus, she 
never reniitted the de'ermiiiation to reach her goal, 
and so we begin with her story of the first small 
beginnings in Italian hospitals. 


The idea that something practical should be attempted 
t.j improve the nursing in our hosi)itals came to me in 
1890 or '91 in Florence. I used often to visit Santa 
Maria Nuova, and we had a little society — composed 
ciiiofly of rich friends of mine — for taking food and 
garments to the sick, so that each ward was visited at 
kast weekly, and fruit, biscuits, cgi;s, wine, tobacco, 
s!!u'T, books, clothes, and little pious jiictures were ^nven 
to the patients. It was not exactly satisfactory — they 
iH'cded so much, and there were so many of them — but 
wi> redressed a few serious evils, as I remember, one 
Italian friend especially having wide inlluence and great 
energy. But the feeling grew: they need some one with 
th^'Hi all the time who is conscientiously good to them 
ami an intelligent aid to the doctors — they need nurses, 
not visitors. 

We heard stories of neglect, of extortionate tips, on all 
.-Mcs; we heard the slafT quarrelling and saw how 
roughly they moved the patients, and wondiTcd what 
they did or did not do wlun no one was there, as they did 
so badly when wc were present. So the belief t^rew 
steadily that I must I'ither do more, or >;i\-e up the little 
I was doing. . . I was free- not too young- with 
suflicient influence to ^et admission;— a stranger, I 
could do wliat an Italian could not (for an Italian 
lady could not live in ho-;pitals or even work there 
seriou.slv; her family would ol'ieet), a non-(^ath()lic, l 


A History of Nursing 

could try to help the nuns indirectly, as others could 

not Jo. . . . 

I believed, and I believe now, that some of us atoms 
of humanity are meant to do one or another bit of work, 
and, despite ourselves, we shall do it. The bit of work 
meant for me was that of the thin edge of the wedge in 
our Italian hospitals— to open their closed doors, that 
others more competent should enter and reform the 
nursing. . . . The thought I held with blind faith was 
—the Uiiuii should be done; . . . no one else seemed able 
to set the example, so I must begin. 

The difticuUies were not slight; at f-rst it was thought 
best to go to England for a brief training, but we found 
that onlv bv offering to learn could I ask to enter an 
Italian hospital. If it was to te,:rh, there were alrea<ly 
phntv of trained nurses, but Italy would not admit 
them! exee])t as outsiders, in ambulatoria (dispensaries), 
therefore it was clear that I mu-t find a hospital which 
would take me as a pupil. The next difficulty was that 
there were only nuns ami servant-nurses in our hospitals 
—I could enter neither group. My friends tried to ^<?i 
me admission as a lay boarder with the Suore at Pisa and 
Cremona, but in vain. 

After some six months Prof. G in Lucca accepted 

the idea of teaching me, that I in turn could teach Itali.m 
pupils. He admired Carman hospitals, and wished to 
pet a better class of nurses for his wards. I tried to 
board in a convent at Lucca, but the hours were mt 
possible, not leaving me free to be in hospital ;— then, too^ 
there were children in the house bi-ing educated, an<l I 
might bring infection in t< them. Finally, through a 
friend's servant, .i family was found, ladies of slemUr 
means who were willing to take me to board, and I 
stayed with them, without causing any gossip, for six 
months, from lanuarv to July. 1H9.V ^'rof. O and 

Prof, ii 

....ri».,f /-InUQ. 

weie Kiiioin..^-> 



and occasionally nights, in their wards, theatre, and 
medication rooms, and ,<;ot a good insight into things as 
they were. The surgical technique taught was excellent, 
h-M nursing? Who could teach nie that? ... A St. 
Thomas's friend now visited me, ascertained that I was 
only learning to be a "surg^"cal or medical assistant," 
and told me I must go to England to see what nursing 
wa>. vShe advised my writing to Miss Nightingale, 
simply stating where I was in my scheme. I rcceixed 
one of our priestess's inspiring letters, then another, and 
another, the third securing me admittance to the Royal 
Edinburgh Infirmary as paying probationer for at 
six months, or, if possible, a year. 

The professors were doubtful as to the wisdom of this; 
thry could not understand why a nurse should need long 
tr^iining;— an intelligent woman could surely get an 
in.!i:ht into organisation and technique in a few months, 
"In six months," they said, "you can return and then 
we will bcgm the school." It was useless to try to 
explain to them; I promised only to return as soon as 
po .ihle, and they were to prepare the way for taking 
iju;,iis. I stayed one year, from October, 1893, to 1894, 
at that delightful and beautiful hospital, the late Miss 
Spencer givmg me every possible facility. The Lucca 
professors meantime endeavoured to get the hospital 
a'hninistration to vote in favour of admitting a better 
class of lay i)upils, but politics as usual intervened— the 
plan was "freemasonic and atheistic." The majority 
voted against it, and the professors' attempts ended in a 
definite defeat. This was a blov. , but the way closing on 
one side meant trying another. 

Koine came to me through friends who were determined 
that my small efforts .should not be so easily ended. 
Piofessor Rossoni, temporarily medical clinician whilst 
Bareelli was Minister of Instruc-tion, was a friend of 
friends of niinn .iinl In. u-c imin/^.^i i,^ .,,j.,,;( . »„ i. 

A History of Nursing 


in his clinic at Santo Spirito, giving permission for two 
or three Italian ^irU to come also and be-in to tram. 
This did not succeed; the right girls were not found; 
and after a few months my friends formed a small com- 
mittee to gain admission to S. Giovanni, the Direttore 
Tosti (who is now Director of the new school m Rome 
and one of its warmest supporters) coming on the com- 
mittee with the surgeon Mazzani. The ladies interviewed 
the Mother Superior, and enlisted her sympathies; she 
promised to instruct the Suore to teach all they could to 
the pupils, who were to be prepared for private duty, and 
it was agree<l that after six months I should be admitted 
to give the finishing touches to their education regarding 
the specialties of private nursing. 

At this juncture one of Queen Margherita's ladics-m- 
waiting, the Princess Strongoli. heard from a mutual 
friend of the strange English lady who wished to start a 
training school. Nursing had always been on the 
Princess's list of feminine professions, as proi)Osed for the 
<drls' college which she was evolving out of the Suor 
Orsola Benincasa ConvCnt in Naples. I was taken at 
eight one morning to talk to her at the Qumnal, and 
convinced her that nursing could not be taught by 
lectures in a school, but required hospital wards. She 
un.lertook to gain entrance to a hosi)ital in Naples by 
September (it was then June), and oiTered me hospitably 
at her girls' school. I went as arranged; negotiations 
were in process, and by November I was working in the 
Gesii e Maria and reflecting ui)on how matters could be 
carried on when I left, for. as I was due in Rome m 
January. I had onlv the intervening time to give i" 
Naples. ' A nurse who knew Italian was essential; we 
made one or two unsuccessful attemi)ts to find one 
close at haiKl: linally I appeal..! t.. Miss (^, race Baxter, 
then in the United States in charge of ;) Nvanl m the 
Johns Hopkins lio.sintal. 



It was one of the inspirations which have attended 
me al the worst moments. She " burnt her ships behind 
hor, " considering that "Italy's need was Kreatest.and 
i. was the land of her adoijtion." In Januar\-, i,S()r) she 
inined me, and, after a brief ti, ic to-ether, I returned 
lo Rmiiu'. I took her jjlaee that summer for a month, 
and then left Nai)Ies to her;— beinf,' trul\- a missionary 
spirit, she has never reproached me, thou<;h from the 
worldly standpoint I was undoubtedly the instrument 
v.iiich prevented her making a brilliant professional 
e:ireer in the States. 

lk>fore taking up the account of .Miss Baxter's 
work, our readers shall have a peep into Miss 
'Iurt(jn' s diaries covering the period just outlined in 
her story; -these daily memoranda give a faithful 
I.ieture of the slow uphill work carried on so 

November 4, 1894. 
I went to ask Signora X. alxjut pupils; she was 
wry amiable. I brought her a letter from .Marehesa 
XX., one of the patrons of her big ijrofessional sehoul. 
Slie said she would find me exactly what I wanted; 
only I must be i)re{)ared to put aside many of my 
■'Kngiish ideas"; I told her I was ciuite willing to do so— 
in tact, I should not wish to retain any ideas that were 
not non-national or founded on the univiTsally aceei)ted 
ethics of nursing; also tliat I had begun my own training 
in an Italian hospital. She then exi)lained that educated 
girls cannot be expected to perform "the menial serv-- 
ices" for the sick— there- must always be servants for 
that pan of the work. I tried without success to con- 
vince her that this was against all rules of nursing. But 
I 'lid not venture to tcl! her that this was the very reason 
the giriN whom .-lie had liad taught in Profes- 


A History of Nursing 

sor 's courses; were not thought capable nurses by pri- 
vate patients, — "nice girls, intelli.^ent ar 1 sympathetic, 
but ur^cless." On one ])oint, however, I found her very 
cnli,nhtened: she allowed that in time, and with tact, I 
mij^ht i;;ct skirls to nurse in men's wards; it would not do 
to mention the matter at first, — she had not told her 
girls even of the possibility, but, after a few months, one 
of the most intelli.^ent and enthusiastic pujnls had 
volunteered to nurse some particularly serious male 
cases after oi^eration. and since then there had been no 
difficulty in getting them to nurse men as well as women. 

November loth. 
I went back to Signora X. this afternoon; she has 
found two young women whom she thinks eminently 
suited for nurses. One I saw, a bright, intelligent 
girl, a chemi'^t's daughter. She informed me that she 
was not afraid of illness, and that she liked making u;j 
prescriptions. ... I went to see the other: "Does tlir 
Signorina wish me to accompany young ladies to the 
Clinica?" Signora X. had not quite explained, but she 
understood it was about young kulies and the hospital;-- 
perhaps her knowledge of French would be u eful if the;- 
were foreigners. ... I exiilained that it was pupils [ 
was looking for and added a little a1)out the work. 
She rei)lied: "Ah Signorina, is it not a life \-ery hard tc 
suppcjrt? I could never venture, and you, also, look far 
too tender-hearted, but even if I had the courage to assist 
the sick, I am all alone in the world, and so would have 
no one to fetch mr in tlie evenings. You see, therefore, 
it is quite imi^ossible for me." ... I see there will be 
the diOiculty of chaperonage; only servants have nii 
traditions to prevent their walking the strcti.s alone. 

X ivember 23d. 
1 am makmg inquiries elsev/here li)r pupils; liie 



chemist's daughter has accepted another engaf^emcnt. 
It is natural enough that Signora X. should keep 

the most promising girls for Professor as he is 

beginning a new covirse of lectures, and admitting a new 
set of pui)ils to his clinic to be taught by himself and 
his assistant; there is no directress living with them; 
Signora X. is nominally such, but she is not a nurse, and 
only gives tne moral support of her presence at lect- 
ures. . . . 

December I2th. 
A promising probationer. Signorina Bianca, has come; 
she is quiet and nice-mannered — shy of the patients, of 
course; she has never been in a hosi)ital ward be- 
fre. I tried to make her feel at homt — no attempt 
at any nursing. ... As we left at seven, Sis- 
ter M — — accompanying us through the wards, I felt the 
-irl was getting frightened ; we talked to her as she walked 
In t ween us, but unfortunately one of the big doors was 
pi'>hed 0]5cn just as we came to it and the porters 
entered carrying a coffm. I saw Bianca grow quite 
'.vhite but said nothing; I put hor in the tram and said, 
'\'() xl-bye until to-morrow, " but my landlady is certain 
ihe will not come again. Poor me . . . 

December 1 6th. 
Signorina Bianca did not appear. Later on came her 
father with a note — she was too badly frightened— she 
returned the muslin and the aprons; this is the end of 
pupil number one. 

December 19th. 
Signorina Antoinette, a promising probationer, has 
been accepted; she has a good manner with the 
patients, is not afraid of them, and is generally self- 
possessed. . . . 


A History of Nursing 

December 2ist. 
I had to talk seriously with Si<;'norina Antoinette this 
morninK', as I found she was callinK the servant for what 
Si^nora X. termed "the menial services," and on my 
refusing' to allow her to do this, she frankly expressed her 
objections to performing; these offices. I told her the 
nurse's code was to do everything in connection with the 
patient herself, and nothing was "low" if looked at from 
this standpoint, as the simplest things often ministered 
most to his comfort. Her answer was that the educated 
nurse should supervise, but that servants should do the 
rough and unpleasant work. As this was precisely what 

was taught at Professor 's clinic, I found it difli- 

cult to convince her that the theory was wrong. In 
fact, I sec that it will be all but impossible to prevent 
the servants from doing these things, which, from the 
Sisters never doing them, have earned the reputa- 
tion of Ixing low ... but which evoke the patient's 
gratitude (and tips). 

December 30th. 
Signorina Antoinette told me to-day that she would 
never dream of nursing, if she were not compelled to seek 
the most paying profession open to her, and she was told 
that it would be far more profitable than mending old 
l.^c^,.__this was depressing, but her truthfulness pleased 
me. She is genuinely good, doing whatever she does so 
conscientiously; still, after this wet-blanket on my hopes 
for a disciple, I was quite moved by an English girl 
telling me. coming out of church, that she envied me 
profoundly, as nursing was the one thing she had always 
longed to do. This comradeship in feeling was very 
con'soling; no one else, so far, quite understands my 
cariu'^ to nurse, and I fear that most people find me very 
f;-„,..^^., f,^,- o.-t-irnir «ii,,ir U(Au in indnrini^ others to share 

the strange j^rivilegc of doing so. 



December 31st. 
Signorina Antoinette took fright this morning at a 
suspicious throat case . . . and came to me after rounds, 
saying she could not conscientiously sta_\-. 

February 17th, 1895. 
Donna M. and I have prepared an article on the nurs- 
in- question for the March number of L' Ora Prcscntc; 
we treat of the need of more intelligent nurses, and of 
opening a new profession to educated girls, who, at 
present, clog the teachers' market. 

vj^ u ^ ■ ^P"^ 25. 

we had a meeting to discuss rules for the Scuola 
Infermiera. The whole matter is extraordinarily com- 
phcated. I am feeling the keenest sympathy for the 
man in the fable who spent his life in getting on and off 
his ionkey, in his attempts to satisfy the moral scruples 
of his friends! 

o , . >pril3oth. 

One of our committee ladies has been to see Signora 
-\., and came back quite depressed over the nursing 
question. The danger of contact with thn docto-s is 
what troubles them. It seems that in the Bologna 
secularised hospital tnere have been verv unpleasant 
scandals. ... I, of eourse, listen to these disasters as to 
M.-nals, showing the need of avoidance of anv semblance 
01 lightness in our pupils . . . and also as proving the ne- 
cessity of the power of dismissal being in our own hands 
• ■ . r always feel that the sense of proportion needful in 
Kuiding others consists in drawing the line justly between 
the not leading into temptation," and the "trusting 
men, that they may show themselves true. " 

Our rules are made out at last. The pupils have 



A History of Nursing 

to be found, but wc have had the following notice put in 
the papers: "School for Nurses: A committee has been 

formed of the ladies aided by Senator ai'd 

Professor — with the object of founding; a school for 
nurses for private cases. With the kind permission of 
the Director-General of the hospitals, the instruction will 
be given in one of the Roman hospitals under the super- 
vision of the sanitarv authorities and the Sisters, accord - 
in- to the rules of the institution. The course of 
instruction will be theoretical and practical and will last 
two years" (the usual requirements and regulations 
followed) . As we cannot offer the pupils either board or 
lod<nng, or salary whilst training, ... and as we have 
had to settle that the pupils should work only half the 
day so as to leave the other half for home duties or 
whatever way of earning they are accustomed to, we 
consider the two years the lowest possible mmimum. 

August 31st. 
I am spending a night in Rome so as to have a visit 

to our five pupils I went to the hospital at ten . . ^ 

they seemed happy, and tola me they Hked nursing, and 
were fond of the nuns and the patients. ... It was 

satisfactory to hear from Professor that all had gone 

well . that they were good girls and the nuns found 

them inteUigent and willing, whUe the patients were 
always singing their praises. 

January 21, 1896. 
I shall now keep the pupils with me, teaching them 
how to bathe under blankets, change, move, etc., without 
exposing the patient. At present I am to have a room tor 
these demonstrations; later I trust there will be no dith- 
cultv about mv showing the pupils in the wards what to 
do and niakini; LiKm ri^si;-"--'-----" •••- •-•■=■■- 


The wards are huge and often overflowing; the 



Suorc and servants overworked, so that we can really be 
of use and comfort, if only the oft-f)rophcsicd feelings of 
distrust and jealously can be avoided. 

January 26th. 
At S A.M. the professor and house doctor went the 
rnunds with the Snore and two of our i)upils. Sister M. 
Cnstina, the head of this ward, is such a sweet woman; 
I um thankful we are to work first in her ward. The pro- 
frshor told her he would like her to put beds in mv hands 
for teaching the pupils, and she was quite pleased and 
anxious to give us the worst cases, saying, "then they 
V. .uM ha^'e more constant attention. " That is the true 
nurse spirit . . . We have two pneumonias, one obscure 
f«v(.T case, and one obscuie, without fever. The ward is 
VI ry heavy, and one can't help seeing, after English 
wards, that want of system in several respects makes it 
heavier. It is painful, too, that backs are not rubbed or 
hair combed except once a week, and consequently bed- 
sores and lice are more or less taken for granted. What 
is well done here is the administration of medicine. The 
patients do not take it themselves, as in many hospitals. 
hut ii is kei)t on a neat little tray and carried around and 
j^iven by a Sister at the proper hours. 

February loth. 
It is rather serious lecturing to pupils who have no 
sense of humour. In telling them the other day of the 
nurse's need of persuasiveness and tact, I mentioned the 
very disastrous habit of allowing a large number of 
persons to be in the patient's room . . . adding at the 
end of my remarks that, if doctors were in question, the 
nurse could not make any suggestion but could only pray 
they would go away. One of my [)upirs note;^, handed to 
T^""- for '^or^Pft ion rr*ir1 • ''Tt" v^ '.'.'iT-i- Viir-n-.f^-. ! f.- \-..--.t.-. i, -. 

many persons in the room, but if they are doctors, the 



A History of Nursing 

nurse shall not make any observation to them, but shall 
I)ray to God that they may leave ! " Ref:;arding a matter 
I have most at heart, they all seem to understand: I 
mean the saeredness of what nurses see and hear when 
peojjlc are in trouble. . . . 

March 22d. 
We have K'^t leave to wash our y)aticnts. ... I spoke 
first to the chirf, who was delighted, then to the inspec- 
tor, v.ho was also quite in sympathy, and told Sister M. 
Cecilia to ])rovide ' asins, rubbers, and soap. This she 
smilinK'ly did, and we be^an this mominj^ — cautiously, 
lest some be alarmed and olijeet. But n(j one mai](> 
dilTiculties, and most were touchinj^'ly j^^'rateful. One 
poor old man did at first retusc, but when asked for thi' 
reason he explained that he was ashamed, as he had been 
ill (or many months and his (vvl had never been washed, 
. . . Those who were up helped to change and fetch water, 
and the wIkjIc scene was most cheery and friendly. \Vt 
gave only two real "bed-baths, " as there were a hundred 
paiient.s, but we washeil the feet of the bed-patients of 
oni'-(iuarler of tlie ward. 

April 25 
The first year's examination is over . . . the ai)litii(K' 
and trustworthiness of our i)upils make us quite happy 
and hopeful of their ultimate success. 

The lime had now conic fornracc Baxter to enter 
upon the scene. The harmony of the sequence of 
events in her careci , by which she was unconsciously 
prepared for her Hfe-work at 1 he very moment when 
it was ready and awaiting het . has been reflected in 
the unwavering; fidehty and cfTuiency that she 
brought to it. Miss Baxter was horn in Italy, and 
had lived her life there u j> to the time when she came 



to America for training; she was, therefore, in one 
sense, an Italian. Her parents were both EngUsh, 
. liolarly, htcrary, and ideahstic;' loving Italy as the 
EiigUsh of their type do, tlicir home was in Florence, 
where Miss Baxter grew up. The writer knew her 
well in the Johns Hopkins Hospital during her train- 
ing: a serious, lofty-minded, most simi)le and direct 
nature, comi)letely averse to all sham and i)retence. 
very quiet as to her opinions, but of great independ- 
ence of mind, holding views on tlic great funda- 
mental questions of life that were untrammelled in 
their natural strength and freedom. Hers were high 
standards of daily living, based u])on truth, just ire, 
and a great compassion for humanity. Immediately 
upon her graduation she left the Johns Hopkins and 
sailed for Naples, where her work lay in the large 
public hospital called the Cicsu e Maria, a beautiful 
old pink and yellow stucco builduig, with largo 
cloisters and gardens. The wards arc old-fashioned 
but pleasant. I ler residence was in a lit t le h< -use on 
the domain of the school for gids already referred to, 
which been establi.shcd in wonderfiilly beautiful', 
picturesque old convent proijerty, built upon a 
scries of terraces with bewildering gardens, corridors, 
cloisters, and salons that lent tliemselvcs perfectly 
to their new uses. 

This giris' school, the most complete and progres- 
sive education ' institution in Italy, had been called 
into being by the Princess Adelaide'di Strongnli, lady- 
in-waiting to her Majesty Queen Marghcrita, and 
one of the really great educationalists of her day. A 
fearless woman and untiring, far-sighted worker, her 
' Miss Baxter's mother wruic under the name " Leader Scott." 


A History' of Nursing 

devotion to the cause of practical education led het 
to become the first patroness of trained nursing in 
Italy, and it is certain that without her firm support 
and steady financial backing the Bhie Cross Society 
(the name given to ]Miss Baxter's nursing school and 
its graduates) could not have existed. In personal 
service, too, the i)rincess has won her laurels, for in 
1S84 she received the gold medal fc- active assist- 
ance in tlie great cholera epidemic. 

Aliss Baxter's entrance into tli' routine of the 
hosj)ital was cfTected very quietly. There were local 
reasons why the nuns had given up the management 
of certain divisions, and in these she began the new 
order. Probably no one with a less complete arma- 
ment of weapons in her i)erfect knowledge of Italian 
characteristics and customs, and her own heredity 
and training, could have maintained this jjosition. 
It was so unusual to see a woman who was not a nun 
in a public hos]jilal, that even some of thr medical 
stafi mistook her motives, and had to be assured that 
she liad come there for work and not for frivolity. 
In the director, however, she had from the t)utset a 
chivalrous, old-school, fastidiously honourable chiet 
and ally, whose support meant evervlhing to her. 

Miss Baxter's letters to America told some of the 
incidents of her hospital work and the often amusing 
obstacles to progress: 


January, i<)()l. 

Have I told you how I .,lartcd my school with three 

nurses, one of whom soon left, while the other two were 

EG well satisfied with themselves that they sailed throiiirh 

their ward work superciliously and listened to my 



theoretical lessons with a scarcely veiled smile of pity at 
the idea of my taking so seric what appeared to them 
elementary knowledge? I had not at that time an official 
position, which made my humiliations all the harder 
to bear. The revolution took place during,' my summer 
holiday ... a new set of d(jctors were elected, who 
knew me and upheld my authority. I was now officially 
accepted as head nurse of — ncjbody knew exactly what. 
My position j;rew of itself, and I have crept up by slow 
di -rces, Kainin^^ or Io-aiv^ ^^round accordiii.i,' as I have won 
or lost the innumerable little battles which I fij^ht every 

clay Aly subordinates are the cross of my life, although 

we are excellent friends, because they do not and ne\er 
will understand so much as the elements of discipline. 
When I returned to Naples in September, I found that ihe 
I'rincess of Strongcjli had been Imsy all the summer pub- 
lishinj,' articles and jzettin),' u]) new subscriptions: the 
result was that tlurc were fourteen new put)ils waiting 
for me besides the three who had be,i:im in June. Of all 
these, ten have just passed their junior examinations. . . . 
Lest I be accused of deliberately departing in my sys- 
teTii from the time-honoured methods of alma mater, 
let me protest that to make any way at aJ! I must insert 
the thin edge of the wedge and not the thick one. Any 
other course would most assuredly end in my offending 
irrevocably the customs an.; prejudices of the country. 
After niuch discussion among themselves, my suggestions 
being waved aside, the staff made out a prngranmie of 
theoretical work. It was decided that there should be 
an hour's lecture given daily to the nvtrses by the phy- 
sicians, the first-year subjects being anatomy, physiology, 
hygiene, surgical and medical pathology; the second year 
gynecology and obstetrics, diseases of children, first aid 
to the injured, diseases of the eye and car, and dietetics. 
On discu.ssing the position of my pupils, tlir Hhie Cross 
Nurses, as their official title runs, I amid not obtain the 


A History ol Nursing 

dismissal of a sin^'lc one of ihc existin.L; "servant- nurses. " 
The result is that my inipils' ward work has never been 
anythinj,^ but voluntary, for, if tlu'y do not perform the 
duties required by the patients, there is someone else 
there to do them. . . . My pui)ils come on duty at 
eiKlu A.M., (■<.)min.i; in frum their home-^, wherever they are. 
They do ward work and make rounds wilii the staff until 
eleven, when the lecture is due. When this .s over I ^'o 
over the lecture of the day before with them, exi)laininf,' 
the difficult passaji;cs. We then return to the wards, and 
between two and three P.M. the pupils leave the hospital 
and return to their homes. . . 

Perhaps you will rea ■ -vhat is reciuired of me when 
I tell you that no nurs> . ''owed to remain in the four 
wards unless I am walking the hos])ital and making 
myself as ubiquitous as ])0ssible. If I go upstairs to 
lunch or to rest for more than a few minutes, I must 
collect my flock, no matter wliat they are doini', and 
take them with me. After the pupils have gone home, 
I spend the afternoon and evening in writing u]) the 
notes of the lecture for them to copy. Though they arc 
lully up to tlie standard of the avi.Tage l^nglish girl in 
social status and refinement, they are too ini'X])erieiiee(l 
to take down correctly the scientific and technical lect- 
ures, and this is better than revising all their written 
notes. At tlie beginning of the year, I wKjte nut a 
programme of the subjects I considered indispen.sable for 
nurses, copied from my hosjntal notes. The chief, whose 
ideas or nursing matters do not difYcr greatly from those 
prevalent in English hospitals, agreed with me Tlie 
lecturers, however, enlarged a good deal on theory and 
technicality. In the course of the year they hiw-^ 
realised that we need simple facts. 

I put my nurses into uniform in February. Tht 
material is rough gingham, striped blue and white, with 
turn-down collars, high white aprons, and hemstilei i d 



half-slccves. Caps would have been a,t;ainst the ideas of 
propriety here, and J did not sii,<;,L,'esl tlieni. 

With rej^rard to ward W(jrk : during' the first few months, 
not having' any ^raihiate nurses to help me, I was obh^ed 
t') leave three out of the four wards to the servants, and 
<;i\e my jiraetieal lessons in the fourth. After six 
iiiuiiths' training' I was able to phice the pupils in eliar^e 
U the wards, always of course under my direet surveil- 
la:icc, and the resuUs have been such that the ward 
pliysicians are fully persuaded of the value of our school. 
The nurses take temperature, pulse, and respiration, do 
u;) the bed patients, and wasli and comb the others, 
catheterise and i^ixc douches, prepare for surgical rounds 
.':::'] nvdieal imer^'encies. assist at operations, distribute 
T-.Adicines, and ^ive hypodermics. What they do not do 
I will try to explain. They are not allowed to make 
temperature charts, lest they should presently usurp 
others of the doctors' functions, Imt I have taught th.eni 
unofricially to keep sf)ecial charts of interestinj; cases. 
lliey may not make beds in the morning except for regu- 
lar bed patients, bed-making time being four P.M., and 
rmt every day of the week either. In the men'.^ wards 
t::''^servants arc forbidden to turn the mattresses except 
en Thursd..ys and Sundays, though the sheets may be 
i!':niged several times a day. TIktc are two reasons for 
tills extraordinary rcRulation: fir t, the floors are washed 
'! :':!y at five A.M. by the servants and any subsequent 
1 ol-making would nullify their work, sweeping being also 
rrohibitcd; second, there is so much phthi,s=.s in the ward 
■' ■■' It is inadvisable to make much dust; for the same 
r.ason sheets may not be shaken out in the ward. 

Bed baths are permitted in theory, but merely tol- 
erated in practice. For this reason I have to get them 
<! !-' in the early morning, before the director and the 
\v;:rd doctors appear, lest on some inauspicious day they 
U- iTohibited altogether, and this in the women's ward.s. 


A History of Nursin^:^ 

In the men's wards, alihout^h I myself might bathe any 
])atienl, the permission is nol extended to my nurses, 
who mr.y only wash the men's faces and hands. The 
general ablutions arc entrusted to the servants, who take 
advantage of the loophole of escape and bathe none 
Nor can I insist. Diets are entirely out of the province 
of the nurses except in the matter of feeding helpless 
patients, and under no circumstance would they be 
allowed to enter the kitchen. Before the training is 
finished they will go through a course of cooking, but it 
will be outside the hospital. . . . The ward cleaning is 
done by the servants, of wlxjm there are three to each 
ward. Their business is to keep the place du.-^td, 
washed, and bunii.shcd, and I must say f<.r them ili.!;. 
with due allowance for circumstances, they do their work 
well. The director does not wish the nurses to int( rl\rc 
with this ])art of the work as a rule, so that they only do 
so in exceptional cases. I feel the less troul)led about 
this, as all my nurses arc taught at home to do housewcirk. 
The disinfection of utensils, linen, etc., and the sterilisa- 
tion of nozzles, instruments, etc. is entrusted to the 

Medical rounds arc carried on in a very delicate man- 
ner when we arc [)rescnt, a feature due to the refining 
influence of the chief. Even in the men's wards there is 
nothing which could shock the most jiuritanical mind, so 
that the pupils' ])arents, who at first stipulated that their 
daughters should nurse only women, now prefer 
wards to the others. The only difTercncc in the system 
of rounds here from that familiar to other nurses is that 
the ward doctor's assistant, instead of ih- head nnrsc, 
takes down the orders. ' . . . 

To illustrate further the difTcrenee in social customs 
in Italy and America, and the inlhience v. hich they excrl 
(^o linspit.'i! life. I \\ i!! tnention that durin<j t he V(\'ir I lia\( 
' Foreign Di-partment, .1. J- A'., Mar(.h-Julv, i')oi. 



had to deal with two love-affairs between nurses and 
doctors. Now this may seem of no ^rcat importance to 
Americans, but in our case the incidents nearly wrecked 
our fr.'ij^nle bark. It is si^mificant of the opinion in which 
!.)vc-afiairs are held, when not carried on under the direct 
;c,L;is of the parents, that the director, when he heard of 
them, behaved as thou-h the affairs had brought dis- 
honour on the whole institution. It was with the very 
greatest difficulty that I persuaded him not to diseharKe 
the entire staff of medical assistants, twelve in number, 
for the offences committed by two only. My jjupils 
bein^,' very youn^', I honestly believe them not to have 
been so much in the wrong as the doctors who had dared 
to admire them from afar, but I could only save them by 
keeping them out ol the way for days after, and as it is. 
thry must take the lowest rank for months to come. You 
will have rcali.sed by now that since the feasibility of a 
"lady nurse" remaining unchaperoned in the wards is 
d nicd to us in the first place, there are greater difhcul- 
t:' m the way of conducting the work of the hos[)ital 
wi'li trained nurses of the educated class than at first 
appear. I confess that I do not yet sec my way throu'/h 
It. A few love-affairs of the kind mentioned, though 
innocent enough in Anglo-Saxon countries, would in 
I'ily ruin a serious undertaking such as ours, to its very 
foundation. . . . 

Our school is growing slowly but surely, and has come 
to he lacked upon as one of the institutions of the city, 
so that only last week we were asked if we could under- 
take the nursing of the big hosi)itai for incurables. Un- 
fortunately our number is too small ior such a colos.sal 
undertaking and we have had to give up the idea for 
the present. . . . Now that our position is assured, we are 
al)le to choose our nurses from respectable middle-class 
Kiniilies, but owing to our exclusiveness we c-annot for the 
present get as many as we need. ... In the hospital 


A Ilistoty of Nursinf^ 

where we were once dedpisetl and ridiculed we arc now 
appreciated and soui^ht after. Wlun tv/o new wanh 
were opened last month the chief, Professor d'Antona, 
requested mc oiTicially to let him iiave enough nurses to 
run them, and his assistants were even heard to say that 
thev could not be opened with'.nu us. We have now 
one hundred and ten beds. Another very satisfactory 
incident was the request of Professor Bianchi, one of the 
tjreatest neurologists of this country, for two nurses lu 
take charge of the clinic for ner\-ous diseases just openi I 
at S. Andrea della Dame. They were duly installed and 
are working satisfactorily. Seven of our graduate nurses 
are in positions as head nurses in this and other hospital.^. 
Manv more could be so placed, but the salaries otTercd 
are ridiculously low. The nurses have more work 
oSTered them than they can do.'' 

Only a few vcars later the Blue Cross nurses were 
firnilv established. They spent the full day in liospiital 
instead of a few hours ; were in charge of seven instead 
of four wards, and in the children's took the entire 
service both day and night; wore uniform and cap 
and were no longer expected to be chaperoned, but in- 
stead held head-nurse posts in a number of hospitals. 
One went to l-iome to the new school as head nurse 
of the ojKTating rooms, and f^. a long time they had 
carried on the work of a small dispensary for ancTmic 
and rachitic children in Naples that was supported 
by voluntar\- contributions. Among those who tlr.-t 
stood alone must be mentioned Signorina Tonino, 
who pioneered in Rome before the new school was 
oi)ened, helping Miss Turton with her little group 
of pupils in San Giovanni. Her work there was aided 

•A. J. A'., June, 1903. 



ami watched over by the Prinress Doria, in the very 
wards wliere an elder jirincess of that name, several 
generations earher, had founded the hardworking 
and practical order called the Sisters of Mercy. Nor 
would the sketch of Miss Baxter's surroundin<^s be 
complete without a line for Signora Adelaide Pagli- 
ara, the secretary and registrar of the Blue Cross 
Society, the strong, practical, gifted friend and ally 
of the school and its pupils, whose encouragement 
often revived hope and chased away depression. 

The growing interest in skilled nursing undoubt- 
edly received a great impetus from the meeting of the 
First National Congress of Italian Women which 
tool- place in Rome, in April, kjoS. This was a 
stirring and most important gathering, attended by 
over a thousand women horn all classes and parties, 
where every detail of the modem social structure in 
its special relation to women, and ever}- aspect of the 
status of women as related to the ])rogress of the race, 
v.tre discussed with earnestness, brilliancy, and learn- 
ing. The nursing question was taken uj) at one 
session, but, regrettably enough, the organisers of 
tlu' congress did not secure the presence of nurses 
themselves ujjon the programme. It is a jjitv that 
Miss Turton, Miss J axter, and Signora Celli had n^t 
been persuaded to rejjort upon the w(irk of nursing 
in Italy. 

Nevertheless the pai)ers read were of great in- 
terest and value. Signora Sciamanna, of Rome, 
an enthusiastic amateur who had worked in the 
Roman hosj)itals as a volunteer, read the leading 
pa])er .stating the nursing case for Ital\- ; she dcscriljed 
it low plane of the injcrmicrc and their defective 


A History of Nursing 

education, long hours, low wages, immoral ten- 
dencies, and absence of discipline. She described from 
life an incident she had seen, where the nurse, sup- 
posedly remaining beside a dying patient to adminis- 
ter oxygen, was in reality so absorbed in a trashy 
novel that she did not notice when the patient ceased 
to breathe. She advocated schools for refined women 
to be annexed to hos])itals, but showed her limitation 
of ideas of a future for nursing, by contending that 
nurses should be prohibited from joining leagues or 
federations controlled by themselves. She had ar- 
rived at this opinion by the fact that the oppressed 
attendants had formed unions and resorted to strikes 
in order to better their wretched economic con- 
ditions. ' 

Professor Mengarini, a woman, spoke also on the 
nursing question; she had little direct knowledge, 
but took a larger view of human liberty and pro- 
tested against its curtailment by the prevention of 
self-governing associations. 

A resolution presented by Signora Dachcr closed 
the discussion. It ran, in effect, as follows: 

The Woman's Congress asks that there may be one 
cducatiouiil iirogramme for all Itahan nurses, to be ap- 
proved by comi)etent authorities, and that no one be 
allowed to exercise; the profession who docs not possess 
the diploma. Tlie admission of candidates should be 

■ The infermifre, long unorganised am! ikfcnccloss, ha<i finally 
funned leagues fur mutual support in the dilTerent Italian cities, and 
by 1903 there were 29 such leagues united in an Italian federatii'fi, 
having a journal called L'/nfrrmirrc. In 1904 this body was strong 
enough to hoKl a national congress in Rome. Through its efforts and 
• r-'liience ma.nv improvemcitts i'l tlie erononiie status of the atlrnu- 
ants had been brought about. 



rr^'ulatcd by the same formalities as arc in use in other 
prnfesriional schools. The principle of equal pay for 
nun and women should be recoj^nisr-d. 

We shall now continue Miss Turton's narrative, 
which traces the steps finally leading up to the open- 
ini: of a model training sc;hool in connection with the 
Polyclinic Hospital in Rome. 

The followin.L,' years held attempts in Rome and in 
Florence which bore fruit very incommensurate with the 
efforts made by friends and patrons, but which brou^-ht 
Pnncess Doria alwaj-s more and more with heart and 
«iul into the crusade. Few ^irls were found to risk the 
chances of success, when we had no home and no pav and 
only insufficient training to offer them. But enough did 
conic forward to ;)rove their aptitude and keep the ball 
rolling, and the Casadi Cura" episode in Florence, where 
SIX or seven Italian nurses cared for private patients with 
some help from English nurses and from the Blue Xuns 
(th,! most sought-after [)rivate nursing order), leaves 
memories of many hajjpy hours. But the ho.spital reform 
was still in abeyance and time was going. A friend offered 
money to start a training school in some hospital, and 
Bolo-na neariy accepted, but a tragedy in the Pro- 
fe^ or's family closed that door. A scheme to run a 

'The Casa <ii (\ira. a private nursinj:; home, was one of the 
crcitions of Turton's e.xecutive energy, anil a notaMe success. 
In the midst of her other undertakings, she also found time to pro- 
jtct, plan, and huild a sanatorium for indpient tuberculosis cases, 
the lirst in Italy. It is near Florence anrl acconmiodates eight girls 
or women. She began raising money (or it in 1902 and it was opened, 
^•!th a nurse in charge, in 1904, turned over later to a society founded 
to ai.l incipient cases, and is now nursed by nuns. It was dcscriljcd 
for the International Tuberculosis Congress in Washington in 1908. 
Sco Transactions; also American Journal of Nursing. NnvrmliPr 
^9o^, p. 124. ' "■ ' 

I lO 

A History of Nursing 

])rivate hos;)ital in Rome was next brouj^hl forward, and 
a shareholdinjj; eomijany formed, bul ihe speculative 
sjiirit swamped the ori<;inal ])lan of balancinj^ payin;^ and 
free ])atients. a school bein^ impossiljlc with only the 
former. It was fated tfiat thiis door also be closed, and 
the buildin;^' was sold before comi)letion. 

New elements had now come into the cam.paif,'n. 
Si.t^nora Maraini (nierrierc Gonza;j;a, wife of a member 
of Parliament, al)Sorbed the fundamental princijdcs of 
pioneer reform, and became the Voice which we had all 
alonjj; needed. Italian, she knew the stand;)oint of her 
com[)atriots; in sympathy with the Princess Doria, Mis^ 
Baxter, and myself, she gradually became the handle of 
the wedge, inserting it with such enlightened intelligence 
that the Polyclinic doors were finally opened to a real 
training school. But this did not come about directly. 
There was first an attempt, after the Women's Congress 
and Signora Sciamanna's speech on nursing, to start a 
school in connection with the Cliniqucs, the Matron and 
pupi' • 'i : in a '".'n-se near-by. The pp '■ -t was neve? 
a satisfactory one, as the Matron would noo aave had tne 
nursing organisation nor oversight of the wards entrusted 
to her, but only the teaching of the pupils within the 

[In the medical Clinique Signora Colli is head and 
in the surgical there was, before her rcmaT-iiagc, 
Signora Sciamanna, each having her own paid staft 
of nurses.] 

Pupils living outside with a third Matron would 
thus have been too literally outsiders, with insufficient 
responsibility. Difficulties closc>d this doorway also, 
then a sudden inspiration seized Princess Doria and Alme. 
Maraini: "Let us make a desperate elTort to get a real 
hospital block to nurse,— Professor Bastianeili's, — and 



gc: a nurses' home somehow in the Pcjlyi'linie. " It was 
only one year a.:;o that this ; ,lan eame into bein.^:. Talked 
of in Mareh, wlien the earthquake excitement had su')- 
siiied a little, jmshed, <j;uided, lifted, dragged, — it was 
finally accepted by Queen, Government, and hospital 
authorities, the ground chosen, tl;c plansdrawn, ai^d work 
begun by the end of June. During the summer the litt Ic 
Home was hurried forward, and on the 28th of February 
Mi-^s Dorothy Snell, Miss Recce, and I entered it. Per- 
haps the most rc-markable feat accomplished by 01:- 
committee was in securing the acceptance of a foreign 
stall as teach(-r nurses. As soon as Italians can be 
trained to replace the English contingent they shall 
assume the posts. The staff, however, does include one 
Italian, Signorina Seiarrino, who was trained in Buffalo, 
Xcw York State, and took post-graduate work in Bor- 
deaux with Dr. Hamilton. The nuns remain in charge 
of hous^aold administration. 

The English Matron, Miss Dorothy Sncll, has been 
described as a woman of great power, intuition, 
and intelligence; very spirituclle and diai)hanous in 
appearance, btit wi;h an iron will — a born leader." 
She and her assistants made a success of their work 
from the first. IMiss Turton lives in the school as 
one of the faculty — a sort of fairy godmother whose 
wand will ward off harm. In a letter to England, 
she described the auspicious opening of the new 

Roma, April 17, 1910. 

Fourteen days ago the little band of pioneer nurses, 

^■ith their first ten Italian jirobati; • '•s, took over the 

nursing of the first surgical ijavnion here — a small 

Lieginning, seemingly, but one which we believe will have 


A History of Xursing 

wide-sprcad'n<^' results, and is consequently worlli \vli;ir- 
cver it may cost in effort. The fourteen days and nights 
have beei' strenuous, physically and mentally. Five to 
eik'ht operations on alternate days, dressings of the ma- 
jority of the seventy-five patients and "spceialing" opera- 
tions and hopeless cases have proved the need of an 
ampler staff, and Miss Conway has come on from Bor- 
dighcra (kindly spared by Miss Bryant),' and Miss Bcau- 
foy is starting from London, to aid with hands, minds, and 
tongues (they speak ItaUan) in the "great endeavour." 

It is difficult to give details of the work — of what is 
being reformed, for we are, in a way, guests in a foreign 
land. Wc want to help, not to criticise. Years a^'o 
Miss Nightingale wrote me, when I returned to Italy 
after my year at the Royal Infirmary, Edinburgh: 
" Patience and prudence, as, ct;., not e.xtollin;,' En,;liih 
things to Italians, c saying, ' I do so and so in Groat 
Britain.'" Theoretically speaking, this standard is the 
only one compatible with courtesy; but reformers cannot 
always wear velvet gloves. Much must be wrestlnl 
with, much uprooted, only we should always aim at 
doififi silently. And consequently it is not an ea-v 
matter to write anything thai is really true all roumi. 
Another saying of Miss Nightingale's often comes back 
to me. A year later, when I was going to Naples, Icavin ■ 
our first Roman inipils to the nuns at S. Giovanni, sh< 
wrote to me: " I am sure you will remember it is only 
personal work that can do things. Stand your grouml 
and kiss your enemy's nose is one of the secrets of lift' 
... A large Tom cat of mine came into the room and 
ran at my two little kittens. The larger and hand^'^mer 
kitten ran away. The smaller stood her ground till the 

» Miss Bryant, a young English wnm;in, had been tniine*! ; ; 
Bordeaux at the Protestant Hospital and did much to aid t! 
Italian movement. She gave Dr. Hamilton an cndowmcn! 
for her tminini' school. 




bis Tom cat came quite close, and then she kissed his 
nose and made i^eace. Now lake uj. your ground, my 
dear Miss Turton, and stick to it. . . . Go on perscver- 
m-Iy and prosper." For all of us these are words of 
really inspired wisdom. If even half of us really succcl J 
in /;z7«,? them, success u ill be a certainty, nay, since our 
leader does live them, even one-third of us, by following 
her. will ensure victory. "Hold your Krcund, but kiss 
your enemy's nose." A smiling' insistence of attitude, 
m other words, whenever ccrlain that the point to be 
grained is undisputahly ri<,'ht. 

The first point thus Rained, I think, was— screens. 
In our hospitals here such "luxuries" are obtainable 
only (and not always) for the dyinK^ But the fust pavil- 
ion now possesses scar'ct twill screens, a vivid note in the 
colourless wards, and one which, with the reallv charming 
green and white frocks of the probationers makes up the 
red. white, and green of ilic Italian flag. The first 
con.llary of screens, systematic washing, is an innovation 
wlueh is almost invariably appreciated. The routine 
evening, "face, hands, and back washing" cause grati- 
tude and surprise. The first night drew forth the remark 
from the Suora in charge, "How quiet the wards wercf 
no one seemed to ring. " And the cure amorose of the new 
nurses seem to make even deeper impression on the 
patients than their skill. The real nurse touch, voice, 
and manners arc a revelation, even when the words are 
limited by being in an r.nknown tongue. 

Already patients are leaving ofT calling perpetually 
lor attention; they have learnt that everything will bo 
d(jne for them in due time— that ought to be done— and 
^■'l!')ut "the hateful tip!"' 

in 1908, Signora Colli contributed another valuable 
study of hospital conditions and schools for nurses, 

RnhJ, 7„, 


A Ilistory of Nursin;^ 

called "Per Ic Scuolc ddle Infermierc" to the Nuova 
Antologia for October. The year of her inquiry 
was 1902. Of 1 24 1 hospitals. 429 were staflcd sokly 
by secular (untrained) attendants; 112 were nurKu 
solely by nuns, while 696 had a mixed staff. [The 
other four were in charge of monks.] The number of 
nurses to this list of hospitals was: secular 83.S(i 
(4613 men and 3767 women), and religious 431,;. 
Of these, some seventy were monks and all the rest 
nuns. vSignora Celli showed that forty per cent, of 
the personnel in question were in religious orders, 
this percentage having risen by ten per cent, in fifteen 
years. As only ninety-three of these hospitals were 
bound by bequests or conditions, it was clear thai 
they preferred the nuns. Their discipline war best; 
they were a superior class of women, and they cost 
the hospital least; even the secular servants cost 
more, while nurses of course were the most expen- 
sive to the administration.' She found admirable 
exceptions to the usual low standard of nursing in 
the work of the Sisters of Mercy and the :Sitorc ddla 
Sapicnza, but emphasised the absolutely unhygienic 
conditions of the Sisters' lives. She referred to a cir- 
cular written by Pope Pius X. in i'j<i^>, in which he 
invited nuns to come in turn to a schucil of instruc- 
tion founded under his auspices in Rome, and coun- 
ocllcd them to lay aside artificial modesty and learn 
to be efficient nurses. Some orders could not, Ic 
cause of their rules, follow his counsel, bm others 
were doing so, and were taking instruction from the 
professors of the iiniversity. Signora Celli showed a 

« .V-cordinR to an ..(Ticial inf]uir\- (if tho Minister <>f tin- Interior, .i 
nur-i i ^;:.t:; ihi^ hwijntal 505 lire, a rvrvant-niir-^- \<^:^, a nun 446. 

Italy and Spain 


marked reform in tlie ...jurs of hospital work- her 
earlier statistics had been useful. She advised a 
complete separation of nurses from ervants, inde- 
pendence of the ward staff from reli-ious rules, . ad 
urged the abolition of the male officials who now 
supervise the nur.cs, and the appointment of trained 
directresses and head nurses, leaving the nuns in full 
charge of the general administration and household 
' ''Homy, 

Miss Amy Turton has also treated the question of 
organisation in an open-minded paper, in which she 
said : 

Such facts [the ligures cited by Signora Celli] seem to 
prove the folly of even contemi^latinK a general laicisation 
01 Italian hospitals, whilst my experience of some fifteen 
years convinces me that, should it be possible, it would 
be the greatest of disasters. For, without going into 
I'^vchological and racial considerations, it cannot be 
(lenic'd that hitherto a large prop( ion of aUruism has 
been absorbed by the religious orders, and in consequence 
u uould need a generation or two to produce in sufTicicnt 
numbers women who would devote themselves, their 
strength, intelligence, and feeling, to the service of the 
siek. without any impulse given by religious belief. 

Slumld, therefore, the seemingly impossible happen, 
and Italy exact the suppression of religious nursing orders 
111 public hospitals, we should undoubtedly fmd ourselves 
deprived of the very element we most desire for pupil 
nurses, since the odium attaching to those who rei)Iaced 
the Sisters would cause even the most liberal Catlujlics 
to hesitate before casting their lot in a camp which 
"••yui.l be designated "atheistic" and "frcemasonic. " 
111'; question would inevitably fall into the domain ..f 
FXjlitico-rcligious conflict, nm] -he .-"iu^p n<" =—:-.- 


.. History of Nursin 

would be grievously dama^'ed or delayed. We would, 
therefore, proclaim from the beginning our desire that 
the nursing question should remain entirely outside all 
polilieal or religious parties. That our object is solely 
that of helping to provide what modern science recognise,^ 
as needful in nursing patients, either in or out of hospital 
— in other words, the formation of the competent trained 
nurse. Whether she be nun or secular should be a ques- 
tion of individual choice with private patients, and of 
the majority in public hospitals. Brielly, nursing, like 
medicine, should be recognised as a non-confessional 
profession. . . . 

The conclusion to which I come is, that ho \niah in 
those towns desirous of bringing nursing up to date 
should start training schools on one of the following 
lines: (a) Hospitals which open training schools to lay 
and religious pupils, (b) Hospitals which confine the 
nursing entirely to a lay staff, retaining the Sisters only 
for economic and spiritual departments. In e:.>'h type of 
hospital the .standard of nursing to be identical, and 
eventually to receive government recognition. In those 
of type (a) the nuns and lay pupils would frequent the 
same two years' courses of lectures, adopt the same 
modern systemiatisation of ward work, and pass the same 
examination to obtaui the same diiiloma. After tw^ 
years from the opening of these training schools only 
those nurses who gained the diploma, whether nuns or 
lay, would be eligil)!e for the posts of head nurses. In 
both types of hospital the ])resent staff of servant-nurses 
would cease to exist. Those who po . essed sufficient 
education and aptitude for the higher training would 
enter as i)upil-nurses of the new school. The others 
would compete for places as ward-maids.' 

The year or u\orv that has elapsed since the auspi- 
' Rcpor::, Intcfiiatiunil Congress oi Nurse?, I-r"n-.iori, 'O'v. ;•- --" 

Italy and Spain 


cious opening of the new school in Rome has brought 
only added encouragement. Its roots seem to be 
well set; the day is i^robably ripe for the permanent 
success of a new era in the beautiful hospitals of Italy. 
Already there are intimations that Florence may 
follow the example, and two charming Florentine 
nuns have appeared in thi' wards cared for b\- the 
nurses of the Scuola ConvUto Rcgina Elena. 

Spain. — Spain must be numbered among those 
countries where the idea of modem nursing is least 
crmprehendcd, as evidenced by the stor>- of a travel- 
iing American nurse, who was obliged to introduce 
herself as a "doctress" when visiting Spanish hospi- 
tals, as no one knew what a nurse was. Yet there, 
too, the first ground has been broken, and in the 
"Rubio Institute" near Madrid a school for nurses 
was first opened and iuv a time tlirove under the 
care of a German Sister, a member of the Girnian 
Nurses* Association. 

The Institute was the creation of Dr. Rubio, who 
was a many-sided genius, far-sighted, benevolent 
and genial, besides being the most progressive and 
scientific surgeon in Spain. He cfTcct.'d a revolutifm 
in Spanish surgery, and was the first to perform there 
many well-known and important opera lions. The 
Institute, for which he obtained funds by a public 
appeal, is a imi(iue establishment, being actually a 
small republic in its government. All the beds arc free, 
and the patients' friends and relatives iiave the stand- 
ing of guests. While the Institute beds are largely 
surgical, a circle of "polyclinics" attached to it give 


A llist()x"\' of Nursincf 

In 1896, Dr. Ruliio first unclcrlook devclopinj^' 3 
school for nurses, and named it after St. Elizabeth 
of Thurinj^ia. Cienius though he was, the rules and 
organisation of this school were as extraordinary as 
could be imagined. The pujjils first takei wire 
fror^ a lowly and uneducated element, and, as there 
was no compulsory free schooling to be h;!d, tlicy 
were positively illiterate. Undismayed by this, 
however, his intention, buoyed by enthusiasm, was 
to give ihem a thorough professional training in two 
years' time. Perhaps to banish all cocjuetry from 
their minds, perhaps also from motives of convenience 
and cleanliness, the nurses were made as hideous as 
possible. Their hair was shaved off, and dark purple 
woollen hoods, made with earflaps and trimmed with 
yellow frills, were set upon their heads. Th^ uniform 
was a (hirk blue striped cotton of shapeless cut, and 
on the breast was worn a large cross in yellow linen 
with the name of the school on it in j)urpie letters. 
A white aj^mn was worn with it, and winter an i 
summer the nurses hail no stockings, only sandals 
on their feet. 

The rules at the outset were exceedingly strict. 
The pupils were neither allowed to m.nke nor receive 
visits, and the |jlan was to keep them so busy that 
they shoukl have no time for relaxation, which mi^'ht 
permit of gossip, or even of thought. Besides the 
nursing, they performed all the work of the i)l;ue, 
cooking, laundrrini,'. and scrubbing. In order that 
they should not become familiar with the patients, 
their work was changed every eight days in a fixed 
routine: kitchen, laundry, hous(-work, women's 
ward, men's ward, eve elitiic. tar clinic i'lP.cra! 

Italy and Spain 


clinic, operating rooms, and Uion beginning again 
Willi the kitchen. Kwn the uircctrcss, who, at first, 
was selected from among the stall, was changed in 
the same way every eight days for some time, but, 
the impossibility of this arrangement doubtless be- 
coming apparent, she was left for one month, then 
for three, and later for a whole year, in her post. 

The first directress to receive a salary w:i^ Donna 
Socorro Galan, who brought about considerable im- 
provement in the domestic management. To her it 
was due that cooks and laundresses were installed 
anil the nurses relieved of so much of the labour. 
i>!u- remained tor alioul si.\ years in her i)osition, and 
during the latter ]);irt of her administration the train- 
in,-; period was lengthenetl to three years and a sum 
of money awardetl to i)upils in the final year if their 
conduct had been meritorious. The hours, however, 
retained tlu'ir media-val and inhuman stamp. The 
nurses were on duty from 5 .a.m. until 9. 10, or 1 1 p.m. 
with scarcely time enough even to eat their mea'S 
in peace, while night duty, falling every third or 
fourth nigh' gave a stretch of from thirty-eight to 
f'lrty hours' continuous service. In additic^n to this, 
if it was thought necessary to discipline or jiunish a 
nurse, it was customary to extend this service even 
further, or send her to bed without food. In all this 
grotesque arrangement there was no intention at all 
of cruelty, but, on the contrary, the most benevolent 
disposition. It was simply believed to be the p oper 
thing. II(jw the nurses survived is a niir.-iele, ;tnd 
that the p;itients did is even more remarkalile. for 
the wards were always full of fresh operation eases. 

In 1910, the Director of the Institute v.a:. Dr. Gu- 


A History of Nursing 

tierrcz, physician to the Queen of S])ain, and under 
his rule (through the (Juct I's in^uence one ean hardly 
doubt, though there is no evidence) the harsh regime 
was mitigated and an attempt made to introduce 
modem methods. Dr. Gutierrez now called to the 
position of Directress a German lady resident in 
Spain, who had taught in Madrid for a number 
of years and had also taken the Victoria House 
training in her native city, Berlin,— Sister Marie 
Zomak. Before entering upon the difficult work 
of reorganisation, Sister Marie went to Bordeaux 
to stay with Dr. Hamilton and Miss Elston and learn 
of their experience and methods in an environment 
similar, in some respects, to that she was about to 
enter. She wrought great changes in the Institute 
Rubio. The hours of duty were remodelled, nij^ht 
duly set for two weeks at once, with eight hours' 
sleep for night nurses, and a day off at its termination. 
The purple hoods were thrown away, and the pupil,-^' 
hair allowed to grow, white linen caps set on it, and 
stockings put on their cold bare legs. A certair 
amount of freedom under jiroper (.'haperonage w. 
provided, and visits from relati'.es allowed. 

Of great importance was the perfected instruction. 
Heretofore the training had all V^een practical, but 
now theoretical teaching was given l)y Dr. Mut, who 
not only devoted himst'lf witii unselfish energy and 
without rcir.unci;:tion to his class work, but was also 
an excellent and sueces;.ful teacher. 

Such changes could hardly take place in a conserv- 
ative country witliout exciting intense disapproval, 
and so it w\is in the Institute Rubio. All iht mori 

mtivent K^nnl 

lenictit^ in<-1iii !iViiT l'i.1,'/.i- »..l-,^ l,-%^t ♦.^I- 

Italy and Spain 121 

a philanthropic interest in the work, believed that 
destruction was at hand, and Sister JMane passed 
throii^^'h a difficult time Tliere was one episode, 
indeed, which left her without any nurses excei)t 
two who remainetl loyal, but at that critical moment 
the whole medical stafif rallied to her side, and offered 
their services to take any necessars' part of the care 
of patients. Sister Marie was on duty day and nij^ht 
for some weeks, and not a patient suffered, nor were 
operations delayed. A truce then followed for the 
summer month ■. and there we leave her, knowing 
that progress is an uphill path, leading through thorns 
and over pitfalls. 



Collaborators: M. Louisi.; Lv^: Canada; Alicf R 
Macuonai.i) and Elli.n Jllia Gould, AusiraHa; 
Hi-STKR Macli.:an. New Zealand; Margaret 
Bui-AV, Africa. 

Canada.- in making a study of hospital and nurs- 
in- conditions throu^'hout Canada, we are confronted 
wilii a great <lifficulty-the lack of a general sehemeof 
viral statistics and rei)f)rts. Si atisties are provincial 
records only, and arc mostly recent and incomplete. 
We have, to refer to, the decennial census whieh 
takes us back to 1901 . There is no Bureau of Public 
Health, and the health agencies of the Federal 
Government are sc-ttered in the various departments 
so that information relative to hosjntal or nursing 
matter can be obtained only from individual sources 
and research. 

In the earliest days of her history and throughout 
the French regime fi535-i759). Canada was indc bted 
wholly to the religious ordc-rs which came out from 
France for the establishment of hospitals and the 
care of the sick in their homes. Some record of the 
heroic and perilous lives of the hospitalicns has 
alreadv been made in (mr f,-cf vni^---" 


: R. 



ic of 








'"■"tliy Siull 


.f \t 





In New Continents 


The early French hospitals (>f wh.ieh wc find au- 
thciuic records arc. in chronological order, as follows: 

St. Jean de Dieu, founded in H)2i). or shortly after, 
at Port Royal in Acadia (now Annajjolisj ; no longer 
in existence. L'HOtel Dieu du iVccieux Sang, at 
Quebec, founded in 1637 by the Jesuits and taken 
charge of later by ilie Augustinian nuns from Dieppe, 
as related,' is still in existence on its original site. 
L'Hotel Dieu de Saint-Joseph 01 Montreal, founded 
by Mile. Mance in 1642 and completed in 1644; still 
in existence. The Hospital for Hurons, founded in 
Sault Ste. Marie in 1642 by the Jesuits and nursed 
Ky them until it was burned by the Irociimis in 1^)44. 
L'n")piial General in Montreal, dating from I(),s8, 
founded by the Sulpiciens and nursed by lay 
brothers until 1745, when a new order, called the 
Grey Nuns, founded by Mme. d'VouvilL , took 
charge of tlic nursing; still in existence. L'llopiial 
General of (juebec, built in l()Ji by the Recollcts 
as a monastery and purchased from them by Mon- 
scigneur St. V'alliei for a hos[)ital; given into charge 
of Sisters from the Hotel Dieu of 'Hiebec in 1692; 
(igurtd in the siege of the city in 1759, and still in 
existence. Two that have ceased to exist are the 
Hole! Dieu at Thice Rivers, founded in if)'*;, by 
St. Vallier and given to the Ursuiines, and a hospital 
at the Fort of Louisburg, founded in 1 7 16 or soon 
after by five lay-brothers of Charite de St. Jean de 
Dieu, who filled the oHices of Superior, surgeon, 
• 11 penser, nurse, and ehnj'! n'n. respectively. The 
annals of all of them are replete with accounts of 
coningrations, ejiidmiic s, -ukI sieges. The lintel 

" .'J iilitoty vj .'f'urMrig, \ Di. i., J) Jiiy. 


A History of Xursini 

Dieu at Quebec was twice burned, the last time in 
1755. when nearly all 'ts uriginal documents wcr^> 
destroyed. The Montreal Hotel Dieu was destroyed 
by fire in 1695. 1721, and 1734. The General Hos- 
pital of the Grey Nuns in ivlontreal was burned in 
1745 and 1765, and the H6tel Dieu at Three Rivers 
in iiS()6. 

Throughout tl:e ravages of the Indians, the con- 
stant wa fare between the French and British, and 
the many epidemics and i)lagaes to which Canada 
fell heir, these hospitals sheltered and cared for 
the wounded and sick. Later, when, in 1775, ^^H' 
Americans invaded Canada they fi>;ured as military 
hos]ntals and barracks. 

The hospitals under religious orders in the Domin- 
ion now number about eighty-four, of whiih forty- 
four arc in (Juebec Province, For the mf>st part, 
they continue along the lines of their original, con- 
servative policies, yet the inllucnce of :lic modem 
si)irit has not quite passed them by, for, within the 
past (iecadc, training schools for nuises have bee ii 
started in many of the vSi';ters' institutions and <-;- 
cellent nurses are sent forth tVom imder their aus- 
pices. The religious orders have greatly increased in 
numbers in Canada, and thc-ir monasteries and 
nosir.tals multiply as the population and opportu- 
nities lor ilinn increase. It is, therefore, hardly 
possible to obtain (()m])lete statements as to thci 
institutions and schools, but we shall i)resently make 
some Record of the most important. 

With the s(>ttlemcnt by the Hritish. hospitals were 
cstablislud under civil or militar>' control, in the 
more thickly populated districts, at sliipping port5 

In New Continents 


and in towns along ihe waterways. Gradually the 
hospital idea grew until now there are found hospitals 
from eoast toeoast, not only in the cities and towns, 
hut throughout the country and sparsely populated 
districts, along lines of railway construction and 
in remote mining camps far north. Some three 
hundred or more, exclusive of military, private, and 
special institutions, exist in Canada, at our writing 
in i<;i 1, while the estimated total number of hospital 
beds is fifty thousand. They are supjjortetl by 
public and jmvatc subscriptions, aided by jirovincial 
or municipal or county grants. Some are entirely 
maintained by the province or the municipalit}-. 
Comparatively few have endowments. 

A brief account of the more })romincnt hospitals 
and Imining schools is all that we may attempt. 

The first hospital, under lay management, was 
founded in Halifax, in 1750. It stood back of the 
present siti- of (iovemment House, an. I, in 1766, 
was granted to the city as an almshouse and used 
as such until iSch), when it was torn down. 

The first training school in Canada, that of St. 
Catharine's, has been brit fly described.' It was 
later given thi- name of its founder and called the 
Mack Training Sehool. This, the oldest school for 
nurses in Canada, and one of the first on the conti- 
nent, has been in existence continuously for thirty- 
seven years, and is to-day one cf the 1 e>t known 
of the smaller training schools. It has an atmosphere 
of distinction and eliarm and i:, in every way a place 
of dignified traditions. The early graduates were 

.1 History oj Nurstun, \'.il. II., pp. 35.}-^55. 


A History of Nursing 

called "Sister" and wore an outdoor uniform, but 
both customs were discarded some years ago. From 
t!ic be^innin<^ the nurses had a separate home, and 
were never housed in the hosjjital itself. 

The first attempt to introduce trained nursing 
into a large civil hosi)ital was made in Montreal. 
'Quebec Province boasts in the Montreal General IIos- 
•pilal the most important, historically, in Canada. 
After the war of iS 12-18 14, and after disbandment 
of the armies in 1815, when Waterloo broke the j^ower 
of Napoleon and settled the ])eace of Europe, there 
was a great influx of emigrants Canada fmrn 
Great Hritain ami Ireland. The winter closing of 
the great waterwa\-s ])revented nLW arrivals from 
going far wes! . fjucbec, Montreal, and Kingston 
were crowded with emigrants, starving, sick, and with 
no means of supjjort. To cojjc with the distress, the 
Montreal l'\'ma]e Henevolent v'^uciety was fouiKud 
in 1816. Through its elTorts, in that \'ear, a lV)ur- 
room house was taken on Chaboillez Sciuare and was 
called "The House of Recovery." The first ])h}- 
siciau in charge was Dr. T. P. Plackwood, a retired 
army surgeon. In iSiS, a large house, cai)able of 
accommodating twi'iuy-four patients. \\:is hired on 
the north side of Craig Street, near Hleury, and was 
called the "Montreal General Ii()Si)itaI." In 1820, 
the land on whi> 11 the iwml of the present hosjiital 
stands was bought. (It was then caHed Marshall's 
Nursery.) The corner-stone was laid juiie (>, 1S21. 
with Masonic honours, and the following ycai the 
hospital was ready for u^e with accommodation 
for seventy patien' . In Januar}-, 1S23, His 
Majesty George IV. gianlLu a Royal Charter. In 

In New Continents 


1S()6, I he land opi)osite the- hospital was bought and 
the old buildings 01: it were removed. ' 

In 1S22, a school of medicine was organised in 
onnection with the hospital and called the Montreal 
Medical Institution. In kSj8, this became the 
Faculty of Medicine of McGill University. This was 
l!ic beginning of the university, and for some time 
th(>medica] faculty was the only faculty, was, in fact, 
M'Clill University. The General Hospital, there- 
1 re, is intimately connected with and is virtually 
r. iHjnsible for the establishment of the university. 

In 1S31, Montreal had thirty thousand inhabitants. 
That year cholera carried off, in three months, one- 
tmth of the population, and it was a busy time for 
the hospital. In 1869, 160 cases of smallpox were 
treated there. 

In an address delivered to the Montreal General 
II"si)ilal Nurses' Club, December 6, 1905, Dr. F. 
T. vSheppard, dean of the medical faculty of McGill 
University, described thus the wards and nursin^; as 
they were in 1867: 

The wards were small and rather untidy, the nurses 
V ( re Sarah Ganii)s. Good creatures and motherly seuls, 

"ine, — all uneducated. Many looked ujxm the wine 
('T brandy) when it was red. ... In those days, it was 
■ Ml the greatest difiieulty patients could be induced to 
.. uuo a hospital. It was the popular heli( f that if they 
V. nt they would never come out aIi\H'. . . \o records 
"rre kci)t. Tlie clinical theriTioTmtt r had hot eoine 
to use; the patients had to look after themselves; fresh 

I- was not thouKht necessary. Armies of rats ilisporled 

' Thr Canadian Xurs,; March, igof). "Mcntrcal Gmcral Hospitai. 

.^. u; :.,^ 

K^irt>opcv.t. i . i. oiit.jJi)aui, .M.iJ. 


A History of Nursing 

themselves about the wards. . . . Instruments were 
looked after l)y a man who assisted in the operatinj^ room 
and at post-mortems in the dead-house. Nothinj,' was 
known of sepsis or antisepsis. Surj^^eons operated with 
dirty instruments and sei)tie hands and wore coats which 
had for years been baptised with the blood of victims. 

In 1875, tlie Committee of Management decided 
to make a cliange for the better, and in the autumn 
of that year Miss Nightingale, who was, of course', 
consulted, and who entered most warmly into the 
project, arranged for a lady superintendent. Miss 
Maelu'n ( a Canadian), one Sister, and four trained 
nurses from the Nightingale school to go to Canada, 
and they entered ujion their duties with the good 
wishes of the public and the hospital authorities. 
The results attenilmg this enterprise were at first 
satisfactory, not only in the su])erior quality of the 
scientific nursing, but in the intluence and example 
exercised by gentlewomen. Their moral influence 
and dignified pnsenie in such an undesirable coni- 
mtmity were not the least of the 1 'nefits conferred. 
Init, tuif. )rlniiately, tliis advanced innovatifin was 
dnnined to failure, and, aftir difTiculties, jealousies, 
restraint, and much unjust publie criticism, the hope 
of establishing a training school was abandoned, 
and, to the regret of their friends, the Ni^ditingale 
nurses returned to Knglanri. Pos-ibly, had they 
liv( (! down the jarring notes and shown a little more 
tact in (U'aling with a difficult pioblem, tin result 
of their advent might have s])elK'd success instead of 

Natural1^^ nursing afTairs then took a rettograde 

^_ ^_ ,-,_-_-* \r*_,(^1. _'- .- . . 1 ™ 

In New Continents 


not a nurse was appointed to take charge of the 
l.-S'ital, and Miss Anna Maxwell (later of the Pres- 
I'Vlerian Hospital, New York) was placed in charge 
of the nursing department. However, this arrange- 
ment, never satisfactory, broke down. Miss Max- 
well, finding herself thwarted in her work, returned 
to thu States, and the matron took entire charge for 
a period of fully ten years, when, in 1889, she retired 
because of ill health. 

Under pressure from various sources the Commit- 
tee of Management realised that they had reached a 
ii'omentous period in the history of the hospital, 
and that, in order to keep in line with modern pro- 
gress, it was necessary that the nursing be taken out 
of the hands of the ignorant and uneducated and 
Kivcn over to intelligent and trained women. A],- 
I'lieations were called for from both England and the 
Inited States for a lady superintendent— a graduate 
troni a training school in good standing. Many 
exi)crienced applicants for the position declined to 
aeeept it when they fully understood the overwhelm- 
ing difficulties to be combated, but it was finally 
undertaken in January, 1890, by Miss Norah Living- 
ston, an American, who had recently graduated from 
the training school of the New York Hospital and 
who brought with her two assistants, graduates from 
her own school. 

In December of that year the school was formally 
opened by His l':xcellency. Lord Stanley of Preston. 
The nursing department was soon in good running 
order and the public recognised and supported the 
nursing ntorni. In i89i,a class of five nurses gradu- 
i. i IK 'ir names were Ellen Chapman, Georgina 


A History of Nursing 

Carroll, Jean Preston, Julia English, and Christine 
Mackay. In 1906, a preliminary course for pro- 
bationers was established, one of the graduates 
holding the diploma of Teachers College, Columbia 
University, New York, being appointed instructor. 

The next large hospital to reform its nursing \v;-.s 
in another and neighbouring province, Ontario. The 
largest hospital in Canada is the Toronto General, 
containing four hundred beds. Its history- briefly 
is as follows: In 18 19 certain lands in York (which in 
1834 became Toronto) were granted by the Crown, 
in trust to four persons for hospital and park pur- 
poses. In that year appeared in the Upper Canada 
Gazette the following notice: 

Proi)osals for building,' by contract a Brick Hospital 
in the town uf York will be received at the Post Ofiice, by 
William Allan, Esq., where a Plan, Elevation and par- 
ticular description of the intended Building may be sctn 
and any information respectinj: it obtained. Proposals 
to be gi\-(.n in within one month from this date. 

York, November 24, 18 19. 

The original York hospital was built on King, near 
John Street. In 1832, it was described as "in success- 
ful operation and alTording to the students daily 
opportunities of observing diseases and their treat- 
ment." In 1847, an Act was p\assed incon:)orating the 
Trtisteesof the Toronto General Hospital. Shortly 
after 1847, the present main building on Gerrard 
Street was ercrird. To it have subseciuently btxn 
added several ailditions. A magnificent new build- 
ing being erectt'd in the centre of the city. (191 2) 
is to supersede the present building 

In New Continents 


Tho training school thai it was proposed to cs- 
tihlish had, like that of the Montreal General, an 
initial period of distress. In the Canada Lancet. 
July 31, 1877, we read: 

It is proposed to establish a training; school for nurses 
in connection with the General Hospital, Toronto. Miss 
Goldic, Lady Superintendent of the hospital, will assume 
tiic manaj^cment. She has had considerable experience 
in the Franco-Prussian War and in British and Conti- 
nrntal hospitals, and is, therefore, tiTiinently qualified for 
such an undertaking. It is proposed to take in about 
t'.vtiity young women, and distribute them about the 
v.;tr(ls of the hospital, where they will have to discharge 
the duties of the nurses already in the place. The i)criod 
of residence will be about six months, and the fees will be 
about fifty dollars for the period, including board and 
l')ii,L,'ing. Appropriate lectures will be given by medical 
,,:i.!Ulemen of the city. Those wishing to enter should 
apply at once to Miss Goldie. 

It was not, however, until four years later, that 
the training school in connection with this hospital 
was really established. The nurses employed were 
Women of the type found in hospitals everywhere 
lirior to the establishrr.ent of training schools. They 
received nine dollars a month with board, lodging, 
and a daily allowance of beer. They occupied bed- 
rooms oi)ening into the wards of which they had 
charge, and each nurse carried her knife, fork, and 
spoon m her pocket. 

The successful changes which had been introduced 
into nellevue, and into the Massachusetts (General, 
encouraged the Toronto authorities in deciding 


A History of N ursing 

to organise a school for nurses, and in April, l88i, 
the entire nursing staff, then consisting of seven- 
teen women, was invited to be T)resent at a me t- 
ing held in the amphitheatre. Addresses were 
delivered, and the nurses were told that a training 
school was to be opened. They were offered the 
]jrivilege of being enrolled as pupils in training upon 
the following conditions: They were exi)ected to 
agree to remain two full years in the hospital and at 
the expiration of that time to pass an oral examina- 
tion before a board of examiners. Those who ful- 
filled this condition were promised a certificate of 
qualification in nursing, signed by the authorities 
and by the examiners, and a silver badge. Only 
five of those present agreed to accept the new state 
of things, and at the ex])iration of two years (1883) 
these pioneers received the certificate and badge of 
the new school. 

After eight years in the hospital. Miss Goldie re- 
tired and was succeeded by Mrs. Fulford (nee Starr}-). 
a graduate of an Enghsh hospital. This lady was 
succeeded in six months by Miss Lucy Pickett, a 
graduate of the Massachusetts General, who in her 
turn resigned after eight months' incumbency. To 
the initiated these brief, quickly relinquished efforts 
to guide the helm are significant of troulilous times, 
of authority helpless and defied, and of insubordina- 
tion where discipline should be. The organisation 
of the training school was still most incomiilelc. 
The nurses occupied rooms situated in \arious parts 
of the hospital ; slept on straw beds ; their dining-room 
was in the basenumt. and they not only served the 
meals in the wards, but washed the dishes. As yet 

In New Continents 


they were little advanced beyond the servant class, 
and their instruction was elementary. At this i)oint 
the real organisation of nursing was taken up and 
with undeviating and unremitting patience carried 
on until fully and roundly developed. 

In 1S82, Miss Mary A. Snively, a Canadian woman 
Willi teacher's training, went to Bellevue Hospital 
from the little town of St. Catherine's. Miss Perkins 
was then at the head of the Bellevue school, and 
when, in 1881 the Toronto hospital trustees applied 
to her for a superintendent of nurses, she, with that 
consummate skill in character-reading, and in select- 
in- the right woman for a post which was her most 
valuable asset, at once sent them Miss Snively, who 
had just finished her course. For twenty-five years 
of unbroken service Miss Snively presided over the 
hosi)ital nursing and the training school. At once 
dignified and genial, with patience enough to wait a 
quarter century for the full fruition of her labours, 
diplomatic and astute in maintaining her position 
a-ainst difficulties, she, little by little, reorganised 
the school on modern lines. 

^ In 19:0, after twenty-six years of service, Miss 
Snively retired full of honours. She was succeeded 
by Miss Stewart, a graduate of the Johns Hopkins. 
The history of these two women, Miss Snively 
and Miss Livingston (the latter at the end of 191 1 
still in her post), is the history- of nursing in Canada. 
Their graduates have gone forth from theL hands into 
every corner of the Dominion, bui!ding, developing, 
reforming, carrying the traditions and atmosphere of 
die schools in which they were trained. To Miss 
Livingston is due not only the efficiency of the 


A History of Nursing 

nursing department of the Montreal General, but 
the high tone and standard of nursing to-ilay in many 
parts of Canada. Miss Snively, strongly soeial by 
nature, has been foremost always in public move- 
ments, in nursing organisation, in the superintend- 
ents' conventions, in committee work, and in educa- 
tional propaganda. Hers is the credit of having led 
Canadian nurses in national and international rela- 
tions and of having cherished the international spirit. 
She rightly regarded the national associations of 
Canadian nurses, and thei-- affiliation with those of 
other countries, as the crowning work of her nursing 

Having followed the leading figures in the early 
trr.nsformation of Canadian nursing, we return to a 
brief summary of the conditions in the various pro- 
vinces, taken serially, and beginning with Nova 
Scotia. What is now the Victoria General in Halifax 
was formerly a military hospital founded by the 
Imj)erial Government. In 1880, the buildings were 
taken over by the local authorities and changed into 
a general hospital under the name of "Provincial 
and C.^j Hospital" for the Province of :\ova Scotia 
and Cape Breton. In 1896 and later, large wings 
and buildings were added. Its present name was 
adopted in honour of Queen Victoria's Jubilee. It 
is supported by the government of Nova Scotia and 
accommodates two hundred patients. Its training 
school for nurses was 'established by the Executive 
Council of Nova Scotia in 1892. Only natives of 
Nova Scotia, men as well as women, are admitted 
as pupils. The men take the same course as the 
women, with the exception of two sp xiaities, and 

In New Continents 


some of them have remained for years in the same 
position. The training of men is regarded here as 
successful. The school had, in 191 1, a roll of forty- 
five students, seven of whom were men. 

The Aberdeen Hospital in New Glasgow has its 
nurses' school; Charlottetown has a training school 
in the Prince Edward Island General Hospital; St. 
Jolm's, New Brunswick, has one organised in 1888. 
PVcdericton was one year earlier with its school 

At Kingston, in 1812, a few citizens b ided them- 
selves together under the name of the Kingston Com- 
passionate Society with the object of relieving the 
distress and sufferings of emigrants. The society's 
work increased, and in 182 1 was taken over by the 
Female Benevolent Association, which, in 1833, ap- 
pealed to the Legislature of Upper ( anada and ob- 
tained a grant toward the erection of a hospital. 
Th.' building was completed m 1834, but owing 
to lack of means the interior was unfinished until 
1^37 when a further grant was received from the 

During the rebellion of 1837-8, on the advice of 
Colonel Bonnycastle the recently completed build- 
in,^' was used for military purposes from May, 1838, 
to June, 1839. In 1841 the building was changed 
to some extent and the United Legislature of Canad?. 
met there until 1844. In that year the Female 
Benevolent Association received permission to send 
ihtnr sick i>oor to the hospital, and a small grant was 
made by the legislature for maintenance. In 1888. a 
training school was organised by the late Dr. Fen wick 
1"' 'nnnection with the hospital. Four nurses com- 
posed the first staff, three of whom graduated. 


A History of Nursing 

The horrors of 1847, caused by the failure of the 
potato crop, frightful famine, and the ensuing typhus 
which made Ireland desolate, can never be forgotten. 
Hundreds of thousands fled for refuge to America, 
many died on shipboard, whole others landed on the 
shores of Canada only to succumb to the pestilence. 
Thousands dird at Grosse Isle, at Ouebc ■, and at 
every port along t he waterways. The hospitals were 
over-lilled and temporary sheds were erected to 
shelter the victims. In (>ebec a private hos] lit al was 
oi)ened by Dn-. Douglas and Racey, who had an- 
ticipated the outbreak. It was on the Beauport 
Brach and acconmiodnted masters of vessels and 
cabin ])assengers who objected to going into cr -'led 
public hosoitals. 

Durinp; the outbreak this place became over- 
crowded and consecjuently the "dwelling house and 
premises of the old breweries" at Beauport wen^ 
leased. One hundred and sixiy-five cases of typhus 
were cared for in these buiUiings, 

; )i. June ijdi, at Point St. Charles, near Montreal, 
hiii'.dreds wer. dying unaided. Three sheds two 
hundred feet long and fifty feet wi'ie v . re built, and 
the Cn-y Nuns went to aid the sufTcrers. In the 
opr!i sjiace betweeti the sheds lay the inanimate 
forms of mrn, women, and children. More arrived 
day by day. Death was there in its most appalling 
form. On June J4. two young nuns were stricken 
'vith shlp-fcver and more followed hourly until thirty 
of ihciii lay at the point of death. Seven dud, while 
those remaining, overwhelmed with exi'austion. 
were obliged . > withdraw. Then the Sisters of St. 
T^.....-u f,-,,.>, ti,,. II.M.l ni.n t(-ok their places. In 

In New Continents 


September the Grey Nuns resumed their heroie task 
ai ihc sheds and eontinued their eharitabk- labours 
not only during 1847-48, but also later, when, in 
1849, cholera replaced the tyjjhus fever. 

At this time the only route for the transportation 
of immigrants to the Canadian West was by Ottawa 
through the Rideau Canal, which had been opened 
in 1832. Over three thousand emigrants reached 
Byunvn (now Ottawa), and with them the typhus. 
The first patients were taken to the (irey Nuns' 
l!"-i)ital. Later, the government built sheds for 
their reception. The nuns continued to c-are for the 
tVver-stricken, and, before the erection of the .special 
■ hcl^, any improvi. 1 shelter such as upturned 
I'oats was utilised. The County of Carleton General 
Protestant Hospital was the outcome of the fever 
epidemic. Many desired a hospital under the con- of the public, to be supported bv public sub- 
scription. This resulted in the formation of a 
board, whose efforts were rewan: d in 1850 by the 
enrtion of the stone building on the lot at the m.rth- 
we ! corner of Rideau and Wurtembcrg streets, hi 
i^^4, Hytown became Ottawa. Tlie original buihb 
ing. until 1875, served as the General Hospital 
and was then used for contagious cases, until 100^. 
when the city opened - -ew I,M,laiion Ho.pital. hi 
l')i)7, the old build in; vas torn down. 

bi I8.)8, the Grey Nuns established a training 
school for lay nurses iti the Ottawa General Hospit d. 
The supcrintendenl of uurMS for m .nie >( ;ir was 
^is'er Mary Alice, trained in Lowi I!. Ma sa< Iinretts, 
at St. John's. Tin graduate nurses were 
in charge nf wards, .nid 

;,n;!;,,. ;.,_ 



A History of Nursing 

effected v/ith the IMaternity and Isolation hospitals, 
thus securing the pupils in their three years' course, 
a full variety of services. This was the first of a 
number of trainint,' schools now manaj^ed by the 
Grey Nuns, of which they are justly proud. 

In Montreal an institution of the hrst importance 
from a medicai and nursing standpoint is tlu> Rnyal 
Victoria, a ,u<-nL'ral hospital beautifully situated on the 
slope oi Mount Royal, overlookintr the city. It was 
establi.hed through the munilicciict' of two Canadian 
peers. Lord Mount Stephen and Lord Strathcona, 
each of whom gave in all a rouiid million of dollars 
toward it. The buiMing was opened in 1N94, when 
the training school was also started. To ojun and 
develop it on tlu most highly advanced plane jios- 
sible, Miss Edith Drai)cr, of a Canadian family dis- 
tinguished for intrlk^tual eminmce, a H( llevue 
graduate and old friend of Miss c^,,ively and Miss 
Ihimpton, was cdlcd fidni tlu ])o^ition she was th-. n 
filling as superintenckiit of the Illinois training; 
school. The Royal Victoria scliool for nurses soon 
came to rank among the best in America. In 1906, 
a moiiiliid preliminary course was started which 
UK hides a domestic science course. The residence 
for nurst'S was opened in 1007. 

Montreal has a splendid modern Matemitv Hos- 
pital, afhliatecl with McCdll UniviTsity, where jnipils 
o\ the Royal Victoria and the Ceneral sc1uk>1s obtain 
their obstetrii- training. 

'I'he Sisters of St. loseph. who have served \he 
HAtel-ni( u of Montreal since l6S(), have seen a Wt^n- 
derful growth in th< ir ho-iiilal, whose early days were 
bO (iraiViriiic 

111 I i • T/ 1 L I V I 1 IV ' \ ■ 

■ >-»'>.■ ■•^•■' •»>' 

In \c\v Continents 


site in St. Paul Street to Pine Avenue, and the Sisters 
now preside over a fine modern building with a front- 
age of 650 feet, covering two city squares, and con- 
taining nearly three hundred beds. The wards are 
spacious and airy, with modern equipment. The 
beds are surrounded by white linen curtains. The 
private wards are large and perfectly equi!)ped fur 
tlur.tpeutic bath treatment. C)])eraiing rooms and 
fittings leave nothing to be desired. The disj)ensing 
i< i)erformed entirely Ijy ihe nuns. In the large and 
beautifully arranged pharmacy a Sister is in charge 
V. ho teaches her skill to the others, while every ward 
lias a nun in charge of medicines and drugs, whose 
'>r y it is to compound, in the pharmacy, all the pre- 
MTiptions and disinfectants needed in her ward, and 
to see to their administration and use. The electrical 
department of the ho>])ital is celebrated for its com- 
pleteness, and was the gift of Dr. Desloges, the 
Sisters supplying the rooms and assistance. A 
training school for lay nurses was oi)ened in 1902, 
ai the instance of Dr. St. jactiues. I?; ginning with 
five pupils, there were, in 191 1, twenty taking a three 
years' course. The lectuns and demonstrations are 
^'iven by the visiting physicians; the nuns, as staff 
and supervising nurses, giving the practical teaching. 
The Sisters, with their novices, are nearly all on duty 
m the wards. They do no regular outside nun ing, 
init are frequently accorded piTinission to leave the 
hospital to pcri'c.rm works of mercy. As these 
Sisters are strictly eloistcnil. t}i.\- niver leave the 
KHMinds without the consent of tlir Archbisho]', In 
Montreal there arc also several smaller Ira-iung 

...t. 1_ T - .1 ! 1 ■. /•/-.« .J .... 

-■..uu;.,. Ill i,K ivi viiy 01 vjutl»ee i^ jiiiu-\' tiaie s 


.\ History of Nursing 

Hospital, dating from 1S64. Tt is a large and well- 
equipped modern building. with a good training school. 

Excellent schools for nurses exist in connection 
with general hospitals in Ottawa, Hamilton. London, 
Gueljjh, and many other Ontario towns, of which, 
did space permit, interesting details might be given. 
In Toronto, the Sisters of St. Joseph have had train- 
ing work in hand longer than those in Montreal 
(for it is not clear that the orders are the same, 
though with the same name), as, at St. Michael's, 
it was begun at the opening of the hospital in 1892. 
The course is three years' medical and surgical work, 
with a three months' ])reliminary cr irse. The Sisters 
supervise in n-ards and operating rooms. 

Manitoba has at least thirty hos])itals and eight 
training schools. The pioneer hospital of the West 
is the St. Bonilacc (nutTal. On April, 25, 1 844, 
three Grey Nuns left Montreal in canoes for the far- 
of? Red River settlement. Th-y arrived at St. 
Boniface, ojijiosite Winnipeg, on the 2 1st of June 
and there in^mediately established the first hospital 
in the West, which has grown to accommodate four 
hundred mmates. A training school was established 
in lSi)o, with a course of two and a half ye;irs. 

The ir.ost important Western h()si)ital, however, 
is the Winnipeg Cuneral. In 1.S71, after the collapse 
of the rebellion, tlu' little colony of Port Oarry in- 
joyed a considcral'le boom, and man; volunteers 
who had conn uji irom tlic ICasl beat their swords 
into plough'^han"; .-md remained as colonists. Other 
immigrant . came in over the Dawson route, or by 
river and cart from St. Paul. Houses were few and 

over-v.r».'Wiu (i, 

illVli Ol\_*VilWOO 

kjl c« 

11. K^ v.* kA h 

In New Continents 


tions were sueh as to render immediate action neces- 
sary. A meetin- was called, a board of health 
furmed, and steps taken to begin hospital work im- 
mediately. A one-story frame house was the best 
place that could be secured, and this became the first 
-encral hospital of Winnijieg. It was not destined to a settled institution without its full share of 
the vicissitudes of the pioneer. For ten years it 
ni>)ved from place to place, doing the best possible 
uork under the worst possible conditions. The 
present location, reached in 1883, v/as the eighth 
(Kvupied. By this time the construction of the 
Cinadian Pacific Railway was well under way, and a 
" n-.e up-to-date hosi)itaI was necessary-. This was 
^:'cted and on Man h i;„ 1884, was opened. In 
i>'J9, a large Jubilee wing was added to the hospi- In 1909. the hospital accommodated three 
hundred and fifty patients.' 

The training school was organised in 1887, and has 
Ht the standard of nursing west of th.e Creat Lakes. 
A nurses' home was built in 1888. Here the nurses 
also enjoy a summer cottage on the lake, the gift of 
friends in tlu' hospital administration. We believe 
this is the only ins!ance in Canada \shiw provision 
for during vacation is made by an institution. 
The hosi)ital retains a large staff of permanent head- 
nurses and (>m])loys a nurse as social worker. 

Alberta and Saskatchewan, togi'ther, have about 
forty hospitals, some of whuh have between fifty and 
one hundred beds. Twt Ive of thr v institutions have 
training schools. In (he ^'nkon. with its frontier 

; 'The Winnipeg; General Hospital," l.y Ethel Jolins; The Cana- 
4>an KuT'.e, June, 1909, p. 2^-i ci scq. 


A History of Nursini^ 

life, nursinj; may l)c seen in sunif of its most pictur- 
esque aspects. There are five hospitals in the 
territory, some of which are nursed by Sisters. 

British Columbia has fifly-seven hospitals with six 
training schools, of which the oldest and best known 
is the Royal Jubilee in X'ictoria, with one hundred 
beds, founded in iS()(). Its school was established 
when the ht)si)ital was built. The Vancouver Gen- 
eral is the largest and most imjiortant in the })rovincc, 
witn two hundred and fifty l)cds. In all these hos- 
pitals the nursinK stafT is ample, numbering, on an 
average, one luirse to thrre jialients. In lumbering 
and mining districts are hos])iials controlled by mills 
or mining interests. Here and there, nurses arc 
found in tents and .-hacks caring for the sick, while 
awaiting the erection of more permanent quarters. 
British Coluniliia is so new that the population far 
exceeds the housing accommodation. 

The Columbia Coast Mission, established in 1905 
by the Rev. John Antle, has three hospitals for min- 
ing and logging cam])S, of which there are thirty scat- 
tered along one hundred miles of i^land-studdcd 
coast. Patients an' brought by the hospital steain- 
boat Coiiin;hia. and sometimes in small open boats. 
At each hospital are a r> sidcnt surgeon, a head 
nurse, an assistant nurse, and a "kitchen-helper," 
usually a J;' ) Here a medical officer may be 
fouml hauling baggage up-stairs, fi'tchiiig hot water, 
or evLU he!])ing t(i cook. Strict discipline, however, 
])revail^. vSpaee tails to ])ermit of a fullc r account of 
the simple ihonj_'Ji anluous life led by cultured 
workers in thi- mission, to which we owe so much in 
ilclpm^ to iiv~v'CK'p liic rcbOuxcco ui liiij ewuiiir^ . 

In New Continents 


Hospitals for C/z/Wz-r;;.— Halifax and Montreal 
have inslitutions for children; the former, founded 
in i<;()9, with Miss Fraser from the Sick Children's 
llo.-;piial oi Toronto. Tlie Children's Memorial, in 
-Montreal, is a K<)od example of affiliat n, for its 
nurses pass throu^'h other hospitals for obstetrics 
and ^'vnecoloKV. The Foundlin- and Baby Hosi)ital 
m 'his city carries on a milk depot, opened in 1 901. 

The most important Canadian hospital for child- 
ren, and one of the most perfect of its kind in the 
world, is in Toronto. Established in 1.S75. its training' 
school was opened in 1886 and has become one of 
the most thorou^di and ])ro^rrcssive on the continent. 
11-^ ratio of one hundred and sixty little ])atients 
om\ sixty pupil nurses, ns well as a sui)ervising staff, 
'lo'.vs that it is well ca. ed for. In i S97, M,,s Louist' 
<-. Hrent, a Canadian graduate i,\ the I^rooklyn 
Ciiy. was placed at the head of the hosjjital and 
ali its departments, and under her rule both school 
■'. i wards have become mo. ids. The hosj-ital owes 
i-ueh to the devotion of Mr. j. Ross Robertson. i)resi- 
'!"!' "f the board of j^ovemors. throu.^h whose gener- 
" :'y a magnificent resitlence for nurses was built in 
")'".. A i)reliminary course for the probationers was 
thi-n established, with trained teachers and lecturers. 
Especial (-mphasis is given to domestic science. The is four months long and is included in the 
three years' term. During training the pupils arc 
sent to afTlliated hospitals for obstetrics and g^me- 
cology. Some two hundred and fifty nurses have 
gone forth from this school, manv to take posi- 
tions as th(> heads of hospitals. Air. Robertson, 
wnose benevolence extends to the whole nursing 


A History of Nursing 

profession, has made il one of his amusements to 
collect a (.'omijlc-tL' lil)rary of nursing literature in the 
nurses' tiotne. He may truly be called the father of 
Canadian nursing affairs. 

During the summer months, all cases of surgical 
tuberculosis, and as many others as j)ossiblc, are 
transferred to the Lakesiclc 1 lome of one himdre and 
twcnty-fiv'e l)cds, a beautiful spot on an island in the 

The Nurses Alumna: Association, organised in 
1903, formed in 1909 the Heatlier Club, with the 
aim of giving voluntary care to tuberculous children. 
IMr. Robertson gave the club a pavilion on the 
grounds of the Lakeside Home, and during the first 
year over thirty children were cared for by the vol- 
untary work of the members, each nurse giving two 
weeks of time. The pavilion then grew to accom. 
niodate fifty, and two permanent nurses were taken 
on, who accept a purely nominal salary as a contri- 
bution to the cause, while the voluntary work 
continues as before. 

In thj great West, Winnipeg has the only hos]iital 
for children, founded first in tem])orary (|uarters, 
with twenty-two beds, in I909, then given a new- 
building of three times that capacity by jiopular 
subscription. To organise its training school in 
191 1 came a nurse from (luy's, in London, Miss 
Elsie Fraser. 

Slate JJospitdls. — I. There is a system of marine 
h.ospitals mainiained by the Pi'deral (lovemment. 
including all seaports. It consists cither of small 
special hospitals, or of arrangements made with 
general hospitals in seaports to care for sick mari* 

In New Continents 


n.TS. The government also maintains hospitals in 
ronncclion with immigration and Indians. 

II. Two Norwegian sailors from a barque called 
TIk' Florida landed in 1815 at (\iraquette, Glouces- 
ter County, N. B. Later two women, living at 
Tracadieand Neguaak respectively, who had washed 
their linen, became lepers. The disease then became 
endemic among the French settlements on the river 
Mirr.niiehi, the shores of the Bale des Chaleurs, and 
in parts of Cape Breton. In 1844, a hospital was 
built for these lepers on Sheldrake Island, near the 
niouih of the Miramichi River. In 1849, the insti- 
tution was transferred to Tracadie, N. B., and in 
I ^'»s placed in charge of the Sisters of St. Joseph from 
Montreal. The lazaretto was at first provincial, 
li'it after confederation became the property of the 
Fi' Irral Government. 

HI. From i8(X) to iS.v various epidemics affected 
localities, but none during that time seem to have 
invaded the whole country. Early in the nineteenth 
century cholera broke out in the Orient; l)y 1832 it 
had ri'ached London, and. with every vessel, the jjcsti- 
lenc(> was expected in Canada. The government 
t'V'k the precaution of opening a quarantine station 
at Grosse Isle, thirty miles below the j)ort of Quebec. 
Temporary buildings were erected there, the station 
was under military control with military nKxiical 
officers, two companies of regulars to do jjolice W(irk, 
and artillery with three mounted cannons to prevent 
i^hips from pas.sing. On the Sih of June the eholera 
roai-hed Grosse Isle, and w(nt by Laps and bounds 
throuchout C.nnndn Wit' in fl,r, 

iti-,.^ ( 


sand persons died in (juebec alone. Since the 


'■•"I.. IV. 


A History of Nursing 

there have been four outbreaks in Quebec Province 
(: ,, 1849, 1852, and 1854). At Grosse Isle, as 
matters passed from imperial to colonial government, 
military medical officers and men were rcjilaced by 
civilians, until finally the station came undtr tl <■ 
control of the Federal C^overnment. Stations were 
also opened in 1832 at Halifax and St. John, N. B. 
Later on quarantine stations were opened at Sydney 
and Louislmrg, C. B., Charlottetown, P. £. I., rii.u 
Chatham, N. B., Vancouver and Victoria, B. C. 

IV. A series of Immigration Detention hospitals 
w-as begun in 1904. They are found in Hahiax, N. S., 
Sydney, C. B., St. John, N. B., Quebec and Moi.treal, 
P. Q., and Victoria, B. C. Graduate nurses are em- 
ployed in them as occasion demands during the ship- 
ping season. The Detention Hospital in Quebec, 
which accommodates five hundred inmates (civically 
and physically unfit) is a particularly interesting 
post for a nurse. 

V. The energies of the State in relation to the 
Indians are chiefly displayed in reference to tuber- 
culosis. A tent hospital of fifteen beds was founded 
in 1908 on the Six Nations Reserve near Brantford, 
Ontario. There is another at Birtle Indian Aj:ency, 
Man. At Morley, in Alberta, is a wooden hospital, 

as well as tents, and in Bri'ish Columbia there are 
provincial hospitals in which are medical superin- 

VI. Hospitals for the Insane. Little is knc -vn of 
the condition of the insane during the French regime, 
and for seventy-five years after the establishment oi 
British rule they were cared for in almshouses and 
jails. The present system is in process of evolution 

In New Continents 


to a more scientific foundation. The training of 
nurses for hospitals for the insane has beKun, the 
first example bein- Ami estabHshed at Reek wood 
Asylum,^ at Kinj^stoji, Ontario, in 1888, under Dr. 
''. i^. Clarke, then medical suixrintendent. The 

)urse, as en cry where at that time, was for t\To years, 
while tht curriculum of study was arran-ed like that 
in the c^-eneral hospitals. This departure worked w on- 
ders in the hospital. Its graduates took post-graduate 
courses in general nursing, and succeeded admirably. 
Dr. Clarke later took charge of the Tr-ronto Asylum 
and established a training school there also. 

In Nova Scotia a school was opened in 1894, in 
connection with the state hospital at Dartmouth, 
with :i, two years' course for as well as women.' 
Trained head nurses are placed n the wan' . Many 
of these nurses have taken supplc-nentary training 
and are filling importa^ • : ,sts in Canada ar.d the 
Tnitcd States, chiefly ni hospitals for the insane. 
The^ Prince Edward Island institution for the insane 
at Falconwood opened a school for nurses in 1900. 
It is a thoroughly well managed and fully equipped 

Though New Brunswick was the first of the prov- 
inces to make provision for its insane, by converting 
an old cholera hospital in St. John into an asylum in 
1S35. it has, as yet. no regul: r school for nurses in 
the iVovincial Hospital at Fairfield, into which the 
original plant was merged .n 1848. The Protestant 
h'j [.ital for the insane at Verdun gives its nurses 
practical training in the care of mental cases, and 

tea('h( them !n:'ncr''1 nnrcinrr \-r> th.'^ infir-rv-.-T-:- l-..i^ 

nas not developed a regular training school. 

1 48 

A History of Nursing' 

of recent times, the ciuestion of nursinj^ the insane 
has been <;i\-en eonsiileration by Mr. Hanna, Provin- 
cial wSecretary.with the result that Ontario established 
a Provincial IJoarcl, and all the hospitals for the insane 
in Ontario (which, as the wealthiest province, lias the 
best ])rovisi()n for these unfortunates), were required 
to develo]) schools for nurses. The board aj^pointed 
an examininj; staff of nietlical men, and uniform ex- 
aminations were held for the first time in 1910 in 
London, Toronto, and Kingston. A third year was 
next added to the training, which is thrown oj)en to 
former graduates, if they desire to take it. Many 
have availed themselves of this opportunity. In 
Toronto and Kingston the lecturers are members of 
the university staff, and exceptional advantages are 
thus afforded the pupils. The board also discussed 
affiliation between schools in general hospitals re- 
ceiving government grants, and those in the service 
of the insane, as a desirable possibility. 

During 1910, in Ontario, male wards for the insane 
were placed in charge of women nurses, with marked 
improvement in the management and well-being of 

Quebec is the only province in which there arc no 
state institutions for the insane. Its several asylums 
are owned by private corporations, though the prov- 
ince contributes to their support and has supervision 
of them. The largest ones a'-e cared for by the Sisters, 
the Grey Nuns taking charge of 1200 patients in the 
Quebec Lunatic Asylum, which is their private pro- 
perty, and the Sisters of Providence in the asylum at 
Longue Pointe near Montreal, with its 2500 cases. 

An immense work is yet to be done in raising the 

In New Continents 


s- itus and efficiency of the great numbers of nursoe 
iKvdt'd to care for these sufferers, and in perfecting 
ihrir education and training. 

\'II. Alditary Hospitals.-- Information regarding 
rarly nnhtary hospitals is vague and fragmentary. 
Tlurc are documents extant, however, relative to 
^'l. h an institution at Kingston prior to 1790. The 
uirliest hospitals for soldiers were, of, the es- 
tahli.-hed institutions at the various towns and posts. 
At .\nnapolis and Louisburg there were hospitals 
t-:at)Iished shortly after the garrisons, and they 
vrvcd not only the garrisons but any sick in those 
I'hKcs. Between the years i75(;-i.Si4 temporarv 
tuld shelter must have been erected wherever the 
WMundcd were not near enough to the established 
hospitals to be taken to them. At Quebec in 1759, 
the British took possession of the city hospitals and 
•-t'vents and erected field shelter outside the city, 
a>- W..11 as on the Isle of Orleans. Shortly after the 
occupation of the British, garrisons were established 
thr<nighout the country, and, in 1793, military hos- 
pitals existed in Sorel, Montreal, Kingston, York, 
Fnrt George at Fort Niagara, Amherstburg, and 
prnhahly elsewhere. The present military hospitals 
"t Canada are located at Halifax, P>edericton, 
JHuhcc, St. John's. Kingston, Petawawa, London,' 
uinnipcg, and Esquimalt, B. C. 

In 1904, a very important addition was made to 
•!ic miliiia of Crmada, when a regulation adacd to 
tile establishment of the militia a certain number 
of nursing Sisters. The Canadian nurses who had 
gone to South Africa had in (n-ory wav iiT^hftrl the 
honour and credit of the militia, and it was' felt right 


A History of Nursing 

that they should be recognised as part of that or- 
ganisation.' The c^iabhshment authorised was 
twenty-live Sisters, who were given the relative rank 
of lieutenant in the army medical corps, with a pay 
of $2.25 a day "vhen on duly, and the allowance of 
tha't r:<nk. When the Dominion Governnunt as- 
sumed vUiu-c of the large garrison at Ihdifax, with 
its mihtary hosjjital of 120 beds, the wani of nur>- 
ing was ;it once fell, and two nursing Sisters were 
added 10 die establishment of the I'ermanent Army 
Medical Corps. Miss Georgina Pope, Royal Red 
Cross (trained in Belle vue). and Miss B. MaedonaKl. 
both of wlinm had served with disiinetion in SouUi 
Africa, wi re appointed to the positions. The Sisters 
of the Permanent Army have been augmented to the 
number of five or six and are stationed at other 
hospitals. Tlie Sisters on the reserve list are recmired 
to take a course at Halifax under ihe nursing Matron. 
Army nursing ii\ Canatla is carried out by the whole 
of the personnel of the army medical service in the 
various military hospitals and during annual training 
at the several camps. The personnel is conipo>ed 
of officers, nursing Sisters, warrant ofiieers. non- 
commissioned officers, and men of ihv permanent 
jnedieal corps and the army mediad corps. ^ Tlu' 
men are trained by the officers .-md nursing Sisters 
If at any time tlie ser-iei> i.l ihe Canadian forco> 
should be needed for the defence of the empire, nur- 
ing Sisters would form a-i important part of then' 
forces. IVefereiiee for I'tiiployment would, of course. 

■ n,- Catfulian Xursr, M.-irrh. too?, P '^O- Ar1i<le hy 0. C 
Juii.-^, Cliii'f Mitieiry M..] Oduir to ilii' iJoniimon. 

In New Continents 


he ^iven to those already holding commissions in 
tht- army medical corjj.s. 

Ami-Tnbcrciilosla 11 "(j;-A'.— Slowly the people of 
Canada are awakeninj^ to the need for an active cam- 
paign against tuberculosis. To wage eflective war- 
fare, concerted action of Provincial and Federal 
Ciovernment is needed, and the dilficulties hitherto 
found in the wa_\- of such action must \v overcome. 
The Federal Government's activities on tl . . line now 
appear in its relations to its w,--ds, ihe Indians, and 
t.) immigrants. With the foimer a beginning has 
Uxn made In- removing afTerted Indians from tluir 
li-mes to tent hospitals on the Reserves. A num- 
l'( r ol sue', outdoor colonies have been provided, each 
one in charge of a ntirse, who also acts as district 
sanitary inspector. Xurses are being emi)loyed in 
ever larger numbers to carry out the preventive and 
educational work ot the various local, ])rovincial, 
and national associations. In Toronto, there an; 
municipal visiting nurses for the tuberculous jxx.r. 
li !., scarcely possible to indicate the extent to whi. h 
nurses are active in such work, as it grov.-s too rapidly 
for figures to be followed. ( )f the hospitals for tuber- 
culosis, most have at least a trained nurse as sujier- 
nituid, /U, while others have an entire stall of 
graduates, and stiil o'Iuts have training schools 
afTiliated with general hospitals. In this is 
the Lady Cirey Hospital at Ottavva, wliieh sends its 
pupils for part of their three years' c ninse to Bebevue 
and Allied Hcspitals in New Vi.rk. 

'/■//, Vntorian rWrr.-The Victorian Order of 
•Virses is the national district nursing association of 
Canada, founded in 1S07 by Lady AbenUrn to do 


A History of Nursing' 

for Canada what the Quccn'.s Jubilee Nurs^!S had done 
for C.reat Brilain; !)ut with this difference, that not 
only are the indigent i)fjor eared for in their own 
homes, but also the people of moderate means. Up 
to 1897, two large classes had been practically un- 
cared for in [jne of illness— the indigent poor and 
the hard-working, self-respecting class who could pay 
something, but not Uie fee of a private nurse. In 
many districts, hospitals diti not exist, and where 
they did, it was often impossible for the patient to 
leave home. The objects of the Order as set forth in 
the Royal Char'er are stated as follows: (i) To suj)- 
ply nur';es thoroughly trained in hospital and district 
nursing and subjet't to one central authority, to care 
tor the sick in tlu ir own homes, in town ami countn,- 
districts. (.?) To luring local associations into affilia- 
tion with the Order and to aflord peeun:ary and 
other assistance to siah local associations. (3) To 
UKiintaiii a high standard for all di, 'rict nursing. {4) 
To a-^i<l in t!ie building of small cottage hospitals 
and homes. 

The chief object was district nursing, and at f.rst 
the activities of the Order were directed solely toward 
th.j end. During the first three years, local associa- 
tions for supi)lyiiig district nurses were organised 
in the large cities and town:,. In the war i(;(X', 
d;i:'ng a loi:r through the Xdrth, -ikI \V(:t, La(iv 
Miiito, then Honorary President of the Order, real- 
ising that the peo])le in remote regions needed more 
adequate nursing care, started a. fu?id as 
"The Lady Minto Cottage Hospital Fund," from 
the interest of which grants are made from time to 
time bv the V. O. towards the building of sm.all 

In New Continents 


hospitals in ou'.-of-lhc-way jjlaccs where they are 
iiMsi nee'led. So from njno on, the work of the ( )r- 
(Ilt has been twofold— di.,triet nursing and liosjiital 
huilding and nursing. In 1909, nursing in eouniry 
distriets was developed. In all parts of tlie Domin- 
ion, especially in the West and xXorth, the cry had 
rM..,e 'o meet the needs of the wonien on the ranches, 
l-.i:es.eads, and farms. This new develo])ment is 
known as "Lady Grey's Country District Nurs- 
•':: Scheme." The plan is to organise local associa- 
■ -ns in large country districts varying from one to 
1 mik's in radius, within which the nurses work. 
^'"titmu )us and visiting nurses are combined. 

i he proI)lem of nursing the people in isolated 
eii>tncts can be solved only by an association of 
IH'ople bound together for that jiurpose. The indi- 
vidual nurse cannt)t solve the problem herself, nor 
is it her resi)onsibilit}- to do so. 

1 here is to-day no ])rovision made lor the training, 
Iirensmg, and inspection of midwivcs in Canada. 
There are a number of midwives from England and 
I'Tcign countries who i)ractise, for the most f)art, 
among immigrants of their own nationality. Sonic 
k<ve been trained in their own countries and manv 
iKive picked up vdiat knowledge they have as they 
Went about. At present it does not seem advisable 
t'» do anything in Canada to enrourage tlu' establi.-.h- 
ment of a training for midwives; but probably the 
tunc w ■■[ com(> wh.en our foreign population shall have 
grf vvn very large, ^<hen it will be imperative, as it 
IS now in (^reat Hritain and '.n ihv I'liitcd States, 
ti) deal u/h this knotty (;r^..iion. In Canada, at 
the present time, old country midwives will not 


A History of Nursing 

solve the nursing problem of the West. Fully 
trained nurses, nothinj^ less, will solve this pr^ bleni, 
and the Ordrr has a eomplete organisation ^or doiiT^ 
the work; funds only arc lacking. 

The structure uf the Order is simple. There is 
the centnd authority, the Board of Governors, eon- 
sisting of five appointees of the (lovemor-Gtneral, 
who is a patron of the Order; of rcpresentativ''s from 
each local association, and from each mi. iit.d asso- 
ciation, both Provincial and Dominioi This man- 
aging board is very representative; i h local as- 
sociation is closely tied with the central au iority. 
The unity and strength of the Order are due to this 
centralised system. Nurses who join the Victorian Or- 
der must be graduates in good standing wf recognised 
training schools connected wiih general hospitals. 
They must have a thorough training in obstetrics 
and must have taken, besides, a post-graduate course 
in district nursing. The work is spreading into othrr 
branches of philanthropic cfTort. In some piarts, 
nurses are employed by the Associated Charities 
with .satisfactory results. In soir.e t)f oiirei:iL'S the 
V. (). nttrses are working as tuberculo.^is nurses, 
often in connection with dis})ensaries or loial bodies. 
In several cities the nurses employed in the public 
schools are members of tlie girder. 

The .Mel)onald College of Domestic Sciiiue .-t 
St. Annt' de lU'llevue employs a Y . (). mirse to give 
lectures tf) the pujjils and teaclicrs. 

There is a nurse on the reservation >>f the Six 
Nations Indians mar Hrantford who works under 
the New luigland MisMonary Society of England, 
founde<l in i()Oi. She also looks after the social and 

In New Continents 


hygienic conditions on the r.^scrvation; for this pur- 
!■ *>c a horsc and tra]) are provided. In many cities 
the V. ( . narses work in connection with the Milk 
C -iimission, taking charge of the depots and also 
i:. tructing the n^, thcrs in the feeding and care of 
infant At Harrington Harbour. Labrador, are 
\'. (). nurses in connection with Dr. Grenfell's hos- 
pital The V. O. hao undertaken the r irsing of the 
i icy-holders 01 the IVIetrc lolitan Life Insurance 
C .mpany, which has 200,000 industrial policy- 
!!'-lders in Canada. The toial number of nurses 
'.yorking for the Order in Kjio was one hundred and 
sixty, distributed as follows: In hospitals, thirty-two; 
in districts,' sixty-four; taking post-graduate Joursc,' 
thirty-seven; nurses in training in hospital training 
srhools, twenty-seven. There are four training 
centres: JSIontreril. Ottawa, Toronto, and Winniijcg. 
New districts are constantly opening up, and as 
the number of branches increases, more fields of 
us.fulness will be taken possession of and tilled by 
the workers of the Order. 

There are several societies and missions employing 
district visiting nurses in citi'-s, and in many places 
nr. jiarish nurses, all doing good work in 'heir 
"'■vn way. W(^lfare w. k, or nursing among factory 
hands, as an instructive vi.-iiing nurse, has been 
introduced into Canada, and r Mre than one large 

' Distriit- Sydney, Baildtx-k, Canso, Unlifax, Yami(.ut!i, St. 
I '■ 'I, Truro, Muntn-al, L.-u-hinc, ShiThrookc, C.rand'Mi'R', Ottawa, 
('"!>alt, Stratfiir.i, Calt. C.ravonliurst, F"iTt Williat WirmiiicK,' 
l.undrcck, Fernic, VaiU(.u\iT, and Victuria. Hospitals: HarrinK'ton 
ilarhuur, Alnioi.te, North Bay, New Liskcard, CopptT CIifT, Swan 
Rjv.T, Minnedosa, Shoal Lake, Yorkton, Mclfort. Indian I had, 
Kasco, Chase, Qucsncl, RiKk Bav. R.ndstokc, .Arn.w Iha.!. 

^56 A History of x\ursing 

factory in Ontario has its welfare nurse. Sone 
of the large departnHnial stores employ a nurse to 
care for customers in c-mergency and to teach hygiene 
among the staff. ,^ ^ ^ 

.^.///.m.,;/.v.-The oldest settlement in Canada is 
m Montreal, m connection with the University Club 
i has been m existence about twelve years and em- 
ploys a. least one trained nurse. The second in age 
IS the Evangeliea Settlement, Toronto, opened in 

M^h this settlement, and effective work has been 
;i-"- ^n modifying and distributing milk to infants 
_r<m, a dc.pot managed by the nurse, as well as in 
.s r tin,. n.others m the feeding of infants, care of 
bo ties, etc. A tlnrd settlement was established in 
(>f 'awa, 1909. So far the work has been chiefly vol- 
un-ary, can-ied on by lay workers. It is hoped to 
•■'^■Muire .ands for a nurse in the near future 

^I^'Ik Connnissio..~Chu^ny through the efforts 
of the om.ns Council in the laiger cities. Mon- 
'7''' '^V'^'"' ^ '''"'''''' Ifamilton, Winn^x'g, and 
o'Jhts, th.Tc.aredrp.u. ^vhere milk is prepared ae- 
;':-'';;^ to tormuhe and distributed to infants. 
LsuaLy a nurse is in c-harg: of the depot an.l a visit- 
ing nurse -s employ.,! to instruct the i)arents Frv 
quently this instruction is given bv V. (). nurse or 
m o,nncvtion with settlemcit or parish nurses'work. 
.Sr/,vW A/.nv;/,;-.-Aecording t.. ihc terms of c.-n- 

of th.. Irovmei.: I'arlianun'. . Efforts Ik^v bc< n 
made to secure recognition of the fact that s:,nitarv 
and medu-al in.pection of schools is a state dutv. 
Lp t- thr present time, however, school inspection 

In New Continents 


and the employment of school nurses arc dependent 
upon mdividual or municiijul school boards. 

In Montreal, through the efTorls of a committee 
of the Montreal Women's CIul,, me.lical insiJcction 
of schools was inaugurated in 1906. In January, 
1908, two trained nurses, one of whom was on the 
\!ctonan Order staff, were engaged by the 13oard c,f 
Health. In March of the same y. ar, the Protestant 
Board of School Commissioners also appointed two 
nurses of the V. O. at their own exi.ensc, and have 
since added another to their staff. 

^^)ronto was peculiarly fortunate in securing as 
<tipcrintendent of school nurses "the first i)cil.lie 
school nurse in America," Miss Lina L. Rogers, wlujse 
(xpcnence in school work in New York has been 
outlined in the chapter on the United States. After 
MX years service there, she was called to Pueblo, 
C olorado, in 1909, to organise school nursing, and re- 
signed this position in resj.onse to urgent calls from 
\hv Board of Education to go to Toronto in Feb-ruary, 
I'jio. Five assistants were appointed in Mav and two 
tr.ore in November of the same year. In February, 
i'Jii, thirteen additional nurses (making a total of 
M venteen) wer- ai)pointed. The nurses inspect the 
children in the classrooms, referring all cases to the 
medical inspector for diagnosis. They treat minor 
contagious skin or eye conditions according to j n- 
scribed orders, visit the homes, instruct the parents, 
explain conditions, and advise. Th(> apjujintment 
of Miss Rogers and the excellent organisation of the 
1 .ronto school work were largi'ly <!ue to the disintcr- 
c U'd labours of Mr. .1. Ross Robertson. 

The school nurses in Toronto recently considered 


A History of Nursing 

the question of uniting the public school nurses of 
Canada for mutual help and co-operation, and, to 
this end, organised the Canadian Public School 
Nursing Association. The Toronto puljlic school 
lioard offers a one-month post-graduate course, under 
JMiss Rogers's direction. Within c-ne year thirteen 
nurses took this course with a view to filling similar 
positions in other cities. In 191 1, school nurses were 
emi)loyed in Montreal, Toronto, Hamilton, London, 
Brantford, Kingston, Stratford, Winnipeg, Regina, 
and Vancouver. 

Education and Organisation. — In considering 
standards of training and the professional education 
of nurses, we find lack of uniformity in all respects. 
There is no standard other than that imj^oscd by 
custom, which varies in localities. Certain schools 
there are which rank among the foremost in the 
world; they have held their own, some by virtue of 
the hos})ital 'ih which they are connected, some 
thiough the inliuence of interested hospital boards, 
but usually through the persistent efforts of individ- 
ual superintendents of training schools. The large 
h')spitals, as a rule, are graduating capable, well- 
cquii)ped nurses. On the other hand, there are 
numerous small and special institutions issu-",T 
worthless diplomas in return for two or ^hrce years 
of hard work and inadequate training. This con- 
dition i)revails, not only in the youthful West, with 
its sparse po;)ulation, but, with much 1 'ss excuse, in 
the East vas well. 

The fiist Canadian schools vith few exccptiotis. 
Were organi'^ed rmd supervi'"ed by women who had 
been trained in the pioneer institutions of the United 

In New Continents 


States, and who modelled their work along the same 
lines, laying down a eourse of training, at first of two 
years, with a curriculum corresponding exactly with 
tliat of the American schools. As changes in methods 
of work and training were introduced, often by 
(:inadian-born women, into the United States, they 
uvre also introduced into Canada. Many suj-erin- 
tm^lcnts of Canadian schools were members of the 
American Society of SuTjerintendents of Training 
Sihools for Nurses, organised in 1894, a society 
which has exerted a marked influence in Canadian 
as well as American hospitals. As early as 1896 
:hv matter of a uniform curriculum was brought for- 
>vard by Miss Snively, then Lady Superintendent of 
the General Hospital in Toronto, and a paper upon 
the subject, read by her at the second convention of 
the society, with the subsequent discussion, had a 
d'finite efiect in Canada. 

The large city hospitals have long lists of appli- 
cants from which to choose their probationers, but 
m proportion as I'ospitalsare remote from attractive 
centres and environment, the difhcuKv in securing 
suitable candidates incn^ases. Scliools which are 
independent as to choice of candidates require a 
hv^h school education or its equivalent. 'Those 
loss fortunate are often obliged to accept such can- 
c^idates as may offer, irrespective of educational 

Pr.diminary courses for probationers have been 
c lablishcd at the Hospital for Sick Children To- 
ronto, in 1906; at the Montreal General in the same 
year, and subsequently at the Victoria, in London, 
and at the Winnipeg General. The Roval Victoria,' 



History of Nursing 

Montreal, has adopted a class system which has many 
advantages. This plan, combined with a modified 
preHminary course, has been found feasible in many 
mstitutions. Two or three schools require a tech- 
nical course or domestic science training previous to 
entrance. While nearly all school authorifes ac- 
knowledge the advantage of the prelimi.iary course, 
the financing ,f such a course has proved the ob- 
stacle to its establishment generally. The proba- 
tionary term varies from two to six months. With 
few exceptions the length of training is three years, 
while hours of wt rk average seventy weekly during 
the entire time. 

_ The custom of affiliating special or small institu- 
tions so as to give a general training is increasing. 
We find many instances of small schools affiliated 
with maternity and contagious hospitals and vis- 
iting nurse organisations, by this method giving 
the pupils the advantages of a thorough general 
training. For the establishment of this system we 
are largely indebted to the registration law of New 
York State, which, while it has no jurisdiction in 
Canada, admits the registration of such Canadian 
schools as meet its requirements and accepts their 
graduates as candidates for registration. 

Most schools still adhere to the old system of 
granting an allowance of a few dollars monthly 
throughout training. Some supply books and uni- 
forms with no allowance. Comparatively few have 
paid lecturers, most of them being dependent upon 
voluntary tuii ion or lectures by members of the staff. 
A few schools offer scholarships and many give 
prizes in competitive examinations. Uniforms con- 

in New Continents 

sisl of the regulation i)rint dresses, white 

p.'-. Graduates usually wear while 1 


aprons, and 

In short, the rul 

incn uniforn. 


and conditions ])revaihn< 

can hosjntals obtain also in Canada — 

traditions, customs, variations of cl 
C(»iditions being almost identical 



iniate, and .social 
, . ,. , -. as well as thepopu- 

lotion, winch consists of the original Anglo-Saxon 
and French, with an increasing proportion of peor.les 
Ironi European countries. Orientals, and an oeca- 
sional African or North American Indian. 

Fields of activity for graduate nurses arc ever in- 
cvasmg. We find graduates in permanent posts 
■n the hospitals, acting as instructors and dietitians 
in institutions, doing office, district, visiting and 
attlement work; school nursing, welfare work in 
Cutones or with the Milk Commission, inspecting 
rq)orcing, and instructing under boards of education 
l^n.i health and with Charity Organisation Societies 
fn-e and there; also doing literarj^ work, while one 
^ t least, m Canada, is the editor of a magazine Priv- 
aie nursing still absorbs the majority, and for the 
t.utful, thoroughly trained nurse, Uiis demand al- 
v.ays exists. Work is obtained through rcdsters 
^'•me of which are managed for private gatn and 
others by nurses them.sclves co-operatively. Gradu- 
ates usually reside, when ofT duty, in Homes or in 
t;raduate nurses' clubs. The position accorded to 
nurses m society or in the homes of patients depends 
entirely upon themselves. 

''ost-graduate courses are rarely taken advantage 
ot m Canada. The Toronto General Hospital ofiers 
a post-graduate summer course. The Hospital Inr 
^K'k Children in the same city has offered a course 





Ui 12.8 


I- 1^ 


\\ 22_ 







1 62 

A Ilistorv of Nursin<r 

in its baby ward. In Toronto, the school board gives 
a month's course :. school nursing, and the Victor- 
ian Order gives courses in district nursing at each of 
its four training lionies. If our nurses wished h,r 
special or post-graduate training the hospitals of 
Canada would gladly arrange for it, to the mutual 
benefit of all concerned. 

At the time this is written we know of two hospitals 
only employing nurses as social service workers— the 
Children's, Toronto, and the Winnipeg General. 
Several have instructive visiting nurses in connection 
U'ith their tuberculosis dispensaries. 

In almost every Canadian city are to be found 
private hospitals corresponding to the "Nursing 
Homes" in Great Britain. They are the private 
property of physicians, nurses, or stock companies. 
They are sometimes supervised by competent super- 
intendents and nursed by graduates, but too often 
by young women, who vainly imagine that they are 
receiving an ecjuivalent in j)rofessional education fer 
their time and energies. These inadequate small 
schools and correspondence schools, together with 
the unrcstrit'ted influx into the Canadian West of 
disquahtied nur.^es and midwives from the United 
States and Great Britain, are an increasing menace. 
not only to the nursing sisterhood, but to Canadian 
society at large, a menace whit-h can be cheeked only 
by tlu- passage of a uniform registration bill in each 

Activity has been exhibited during the last decade 
in the formation of alumna? associations and Icwal 
clubs and societies. In the different provinces, or- 
ganisations are forming with intent to obtain state 

In New Continents 



registration. Because of our polii 

province must have its own act. In the past, there 

iias been lack of organised concerted action by the 

Tir.rscs of the various provinces, easily explained by 

<i -ance and by the early stage of co-oiuTative 


Provincial associations, in 1911, are found in Nova 
Scotia, (Hiebec, Ontario, Manitoba, and Saskatche- 
wan. That HI Quebec is the oldest. ha\ ing been 
tounded in 1895 in .Montreal, as ihe Canadian 
Nursing Association. It is affiliated with the Na- 
tional Council of Women of Canada. That in 
Ontario, named the (^.raduate Nursing Association 
()t Ontario, founded in 1904. had in iiu- Mibsequent 
nine years made three praiseworthy but fruitless 
a::ympts to carry a registration act through the 

Local associations of nurses are numerous, all fully 
a'lf-govcrning, and every year they are becoming 
more influential and useful. 

The Canadian Society of Superinti'ndents of Train- 
ing Schools for Nurses was established in March, 
i')<>7. Miss Snively. whose rfTorts in its l)ehalf had 
'"'■" largely responsib e for its rre.-ition, bccnme its 
!i' ' l) and immerliately threw all her energies 
-".i prestige into the work of bringing a national 
society for nurses into being. 

J^nnng all the later years of hir work as super- 
iniendent this had been lu r i)]an. signified long ago 
I'y her standing in the International Council of 
Nurses as a (\Mineil]..r and Honorary Vice-I'nsident 
for Can.uJa. for tlie inirpose of the International is to 
unite national bodies for mutual .nrn^ .-m,! .,,.,. ;..f.c 


A History of Nursing 

Miss Snivcly's good offices were successful at the 
second meeting of Uie Canadian Superintendents 
m KjoS, as a nati(jnal society was then inaugurated 
and a provisional association formed, called The 
Canadian National Association of Trained Nurses. 
The \\el!-nierited honour of the president's place 
was offered to her. and under her lea.lershiij Canada 
I'ntered the international group in London. 1909. at 
one of the iTiost picturesciue and stirring functions in 
which uirses have ever taken part.' 
^ At t e fifth annual meeting of the Canadian 
Society of Superintendents, the work lying to hand 
for the nurses of the Dominion was' graphically 
summarised in Miss Snively's opening words: 

_ And now let me enumerate the ol.jeet.-, of our associa- 
tion; "To eonsidir all cjuestions relating to nursir,,^ 
oclucation; to ,kfin;. and maintain in seho(,>ls of nursing 
throughout the e.,untry minimum standards for admis- 
sion and K'nidualion; to assist m furthering all matters 
pcrtamiuK to puMir health: to aid i„ all nnvisures for 
public good l.y co-oi'., ration wiih other ••(! icatiunal 
bodies, philanthropic and social; to promote by mcetin-N 
papers, and discussions cordial Halations and fellowship; 
and in all ways to develop and inanUain tlu- hight-t 
ideals in the nursing professi.m. " i-very clause tin re 
means work. The question of registration is one of 
suim nu> niiportance at this very time, nnd ic is from this 
society, composed lar-ely of tli.' oJ.Kt and more exi)eri- 
enced women in the profession, that help : hould he 
expected. . . . Then. too. the influence we tnay ex. rt 
•m .-il! .|iH lions of public health and its allied depart- 
nieiits. all those matters whieh we roughly sum uu as 

■.Socon.l Q„im,i, Mr.tinR of fh.- International Cnuti, il d 
Nurses. Mrs. Beiiford Fcnnick, I'nMdcnt. 

In New Continents 

1 6.= 

social service problems, is very preat. We are demand- 
ing' more and more in our profession that our members 
1h- women of broad sympathies and culture, and, if ^uch 
are to be encouraged, wc^ must look to <.ur superintend- 
ents of nursr-s to see to it that such qualities are fostered 
m their pupils. And, too, the social side of our society's 
w. )rk IS of Kreat importance. Wv are all bound to^^elher 
by ono bond at least of sympathy and we must try to 
Know one another and work together. . . . Following a 
su-'cstion, an effort has been ma.le to arran^'e for talks 
to colle-e women on nursing-, with a view to attracting 
the collc-e trained woman, especially for social service 

r •■, ■ ; .J^" '°''''"^^' ^' affiliated with the National 
Council of Women, and a report will be heard of its 

Work. . . . 

In Canada, as in the United States, there is a 

society, tounded in 1907, of hospital superintendents 

< v.ho may be either physicians or laymen or nurses) 

''■any of whose members are nurses, hol.Iing positions 

a; the head of institutions. It had hcvn proposed 

tnat the society of training school superuUendcnts 

should form a subsection of this society, and meet 

^^'^h It. The report hrou^du in by the committee 

"1 rc-ard to tins proposal was a frank and fearless 

one. and merits careful reading for its dignified self- 

assertion. It ran: 

This committ<v bei:s to recn,nn,rnd that this society 
do not amalgamate will, the C\-madian Hospital Asso- for the following reasons: (i) There - 
t'louK'h work to be ,lune in connection with training 
schools to keep one snriety busy, and the Canadian 
N.nety of S„perinten |,.nts of Tnuning Schools for 
iNurses can do liia; work better ,„,,r,. „<To^»:,.,-,.. ._., 

ntC tlv v:^ , .;;;U 

i66 A History of Nursing 

more sandy when it preserves its identity. There are 
many problems fur this soeiety to solve, for with its 
members really rests what the nursin.<,' profession is to be. 
(2) This society in its membership is strietly professional 
and educational. (3) It has been claimed that the union 
would make for economy— bargains are verv doubtful 
blessings; that all would reap the benefits of the papers, 
discussions, etc. But that may be obtained by arran-inij 
meetings as ihcy are arran-ed durino^ this convention; 
they are held at the same place and programmes are so 
worked out that members from both societies may 
attend all sessions, and union meeting's and conferences 
may be arran^'ed for as desired. (4) This society would 
gam not hill- by the union, for the members (;f the Hos- 
pital As.oeuition know necessarily very little about the 
trainin- of nurses, whereas the superintendents of train- 
in- schools know a prcat deal about the manat^ement of 
hospitals. The object of thi.-, association is to study out 
all the [)hases of traininc,' school work, .so that its members 
may be mistresses of that branch— authorities— to whom 
all such matters should be referred. 

By all means, kl us have ^^-mpatlietic co-operation, 
friendly, helpful interest in each other's welfare, but — 
and this should be the watchword of our profession to-day 
—let us hold fast to this: We are specialists in trainiii- 
school mat ters ; we are mistresses in t hat !)art • .f the work, 
and nothing should make us -ive up that place. Let us 
liold fast to that, take nothing less. It is in this 
society, composed, as it is, of professional women of the 
hiK'hest tyjie, that such truths will b, foiten-d, that we 
shall, by careful study, build up our ideals, know what an 
inlluence we may be, and so be able to take our stand 
where it is intended we should. 

The refiort uat, presentetl 1)\- Mi.s^ Mary A. Mac- 
kenzie, Chief Lady Superintendent of the Victorian 

In New Continents 



Order of Nurses, and was adopted, 1} 
the society an untrammelled existence. 

With a view to assisting the \-arious provincial 
and alumnas associations, the Society of Superin- 
ttndents of Training Schools appointed, in 1910, a 
committee to consider standards of nursing education 
and registration and to confer with the i^rovincial 
MK-ietics as to ^he drafting of a bill to meet the needs 
"! nurses in all the provinces and, later on, lead to 
intcrprovincial registration. This committee con- 
sisied at first of Miss Mackenzie, Convener; Aliss 
Louise Brent, and Mrs. Fournicr, who were de- 
signed to be the nucleus of a large committee consist- 
;ii- of representatives from the national and from 
(ach provincial association. The work of this com- 
mittee was to prepare a model bill to hv presented 
Ik fore each provincial legislature, the result hoped 
for being — Dominion Registration. 

The general scheme included affiliation witli central 
t' hnical schools, universities, or groups of hospitals, 
^" as to make thorough preliminary and didactic 
instruction possible without increased iinancial effort 
<'n the i^art of individual hospitals. 

'I'lie Canadian iXnrse is the official organ of all the 
• organisations among nurses in Canada, it appeared 
!-■ i m 1905 as a quartirly, under the managt nient 
' ! a publication committee eomposetl of nitnibers 
"I die alunuKC iissociation of the Toronto (ieiKTal 
Hospital. Jn another year all the alumna> societies 
m Toronto were on iliis committee, and in 1907 this 
l"al ])ublication committee was replaced by a 
l""adly representative editorial board, with a 

1 68 

A History of Nursing 

Miss Bella Crosby told the story of its growth, in 

It is to an impulse from the threat Canadian West that 
we owe tiie foundin<,' of our national nurses' ma<,^azinc. 

Miss Lennox, the president of the Alumnae Association 
of the Toronto Gene-al Hospital in ic)()4-()5, had resided 
for some time in Alberta and had an opportunity to 
realise the need of such a ma<,'azine, not only in the cities 
out on the prairies. 

Also it is to be remembered that the Association of 
Graduate Nurses of Calvary, Alberta, wrote to the 
Toronto Medical Society about the founding of a nurses' 
journal almost at the same time. 

In the presidential address of Miss Lennox, delivered 
in November, 1904, she said: "The work I most desire to 
accompHsh this year is the institution of an alumnae 
journal. . . ." 

At the regular monthly meeting of the Alumna? Asso- 
ciation of the training school of the Toronto General 
Hospital for December 13, 1904, Miss Hodgson gave a 
paper on the advisability of publishing a periodical. 

A committee was then formed, composed entirely 
of alumna^ members, to promote the enterprise. 
The greatest difficulty was to find an editor, and 
finally the nurses persuaded Dr. Helen MacMurchv. 
an old friend of Miss Snively, and well known for 
h(T public work of many kinds, to fill the position 
until a nurse as editor could be secured. 

Already the magazine was assuming a national charac- 
ter. ... It enlarged rapidly; Montreal, Winnipeg, and 
other cities lent aid, and b( fore the end of a year, the 
Canadian Xursf was th{> ofiici.-il or.'^n nf , i.rt,i c.>f.;,.t;,^ 

In New Continents 


. . . The first year closed with a well-cstabHshcd journal, 
free of debt and with a small balance to its credit. Both 
editor and Inisiness manager were paid a modest sum 
for time and worl^ K'-'nerously ^ivcn. . . . Great ser\-iccs 
were rendered by Miss HarKTave, who pro\-ed herself, 
iroin the bcKinninK, an ideal editor of one of the most 
important dej artments of the magazine, and endeared 
herself to the committee and to the subscribers Ijy her 
unfailing loyalty, interest, and enthusiasm. The same 
may be said of Miss Mitchell, the convener. Miss Hodg. 
s.»n, the assistant editor, and also of Miss Christie, the 

iness manager, whose work in that department was 


admirable ' 

In 19 10, Miss Bella Crosby, a graduate of the To- 
ronto General, was made editor, and an editorial 
board was formed to represent every province and 
every nurses' association in the Dominion. V'ukon, 
Labrador, and Newfoundland have their representa- 
tives, and even the Canadian nurses in the United 
Slates have one, upon this board. The Giuadian 
.^ urse has a future of importance before it, in welding 
tlie nurses of the broad provinces into one united 

Hot ween Canada and tlie United State? there has 
always been a lively re.-ii)rocit_\- in nursing atTairs. avenues of self-support for cultured women 
-r.' tewer in the former, more conservative, country, 
'he career of nursing has attracted there a pro- 
portionately large number of exceptional women, 
-any of whom, in the United State-., have found 
>iI)ounding oi)portunities, and, in return, have con- 
tributed notably to professional progress. Across 

The Canadian Xusr " Rcport.s,'' Paris Conti 

cienco, 1907. 


A History of Nursing 

the border, freedom to develop initiative is greater 
and more room for experiment is allowed. To a 
certain extent, British conservatism checks the Cana- 
dian spirit at home, and medical guardianship of 
nurses is, in some centres, fairly strong, while the 
fell influence of the London group of reactionaries 
is occasionally perceived in the hospital atmosphere. 
But nurses realise more clearly every day that they 
must work out their own salvation. To-day is the 
dawn of organisation and progress. 

If you will only multiply the smallest force by time 
cnouKh, it will equal the greatest; so it is with the slow 
intellectual movement of the masses. It can scarcely 
be seen, but it is a constant movement. It is the shadow 
on the dial— never still, though never seen to move. It 
IS the tide — it is the ocean, gaining on the proudest bul- 
warks that human art or strength can build. It may be 
defied for a moment, but in the end it always triumphs. 

Newfoundland, the independent little British col- 
ony, conservative, and cherishing its individuality 
has given the profession of nursing some of its best 
members. Its first hospital was a military one in 
St. Johns, first in use during the middle of last 
century. About 1870 that series of enlargements 
began which now make it a general hospital main- 
tained by the government, and having a capacity 
of something under 150 beds. Only ten years ago 
training was unknown in Newfoundland' nursing. 
To celebrate Queen Victoria's Jubilee, the women of 
the island gave the general hospital two wards ^or 
women, and in 1903 a training school was organised 
u::-^i'o -^j iviiob ivi. oouincuLi, w'iiKj cuuie trom England 

In New Continents 


v\iih the certificates of the London Hospital, the Lon- 
don Obstetrical Society, and the Plaistow midwifery- 
course. This school, still small, has an excellent 
three years' course covering all branches of work. 
Near the General is a government hospital for con- 
tagious diseases, and a convalescent home founded 
b\ the " Ladies of the Cowan Mission " in mem.or>' 
of the hospital's first Matron, Miss Cowan. The 
government also controls the hospital for the insane. 
Anti-tuberculosis work, well under way, is partly 
under private and partly under governmental direc'- 
ti' .n. ^ At the camp started by the Daughters of the 
Empire, a St. Johns General graduate, Miss Camp- 
bell, was the first nurse to take charge, and the same 
hospital supplied the trained women who initiated 
visiting work in the city and outposts, and who, in 
the summer, make the tour of the whole coast. Nurs- 
ing organisation, spoken of but, up to 191 1, not 
brought about, must soon come, 

Labrador.— Upon the coasts of Newfoundland and 
Labrador is carried on one of the famous missions 
o: I he worid, known widely and well as Dr. Grenfell's 
v.ork among the deep-sea fisherfolk of the Northern 
coasts. Wilfred Thomason Grenfell, whose spirit 
nnbues the whole, was born in England in 1865 and 
engaged as a medical missionary in the work of the 
Royal National Mission to Dccp-Sea iMshermen. in 
1889. He fitted out the first hospital ship for 
British fisheries in the North Sea. and n iS(,2 went 
l'^ Labrador, where he devotes himself to the religious 
and industrial improvement and the medical and 
nuioing caicoi ihe people. A man ot keen practical 


A History of Nursing 

sagacity and mucli magnetism, he has enhstcd nurses 
to licl]) liim, whohc Hves and duties are among the 
most picturesque in all the annals of district nursing. 
A Canadian graduate of the Illinois training school, 
Miss Edith Ma\-ou, became his chief head nurse, 
and the alumucX' of the Johns Hopkins school under- 
took a sort of sisterly resi^onsibilily to keep his staff 
filled, and have sent several of their Canadian mem- 
bers to posts in Labrador. The Mission has five hos- 
pitals, four on the Newfoundland and one on the 
Labrador coast, while other stations are opened up 
\\'arly, wiiere the boats call to treat and transport 
pati-nls. Original articles by nurses in the Ameri- 
can Journal of Xiirsing and that of the Johns Hop- 
kms Alumnai Association give graphic accounts of 
their life among the simple seafaring people and well 
merit a transcription, for which our pages are too 

Australia.— A hundred years ago, in October of 
1811, the iirst hospital erected on Australian soil was 
opened for the reception of patients. With the 
Sydney Infirmary (now Hospital) the history of 
nursing in Australia begins. Were it possible to 
obtain a faithful picture of hospital life in the early 
days, we should, no doubt, be surprised at the rajjid 
strides made by the nursing profession in the last 
fifty or sixty y.ars. For although some of the hos- 
pitals date back to the earlier decades of the L-st 
century, the nursing practised within their walls 
was very primitive. The early Matrons were house- 
keepers, who attended to the feeding of the inmates, 
and the care nnd rli'nnci'ncT ni" tV-^ v./--...-^ t- -■- — 

In New Continents 


corded of most of them that tlidr institutions were 
models of cleanhness. whieh is, eonsi.cring the di- 
advantages under v;hich they worked, a reeord of 
nu mean attainment. 

As early as 1868, however, a training school was 
established by JMiss Lucy Osburn, Lady Superin- 
tendent of the Sydney Hospital Miss Osburn was 
one of five Nightingale nurses who came from 
England m March of that year. The Australasian 
^urses Journal^ says that she and her companions 
were specially selected by Miss Nightingale herself as 
suited for work in the colony, at the request of Sir 
Henry Parkes, who had corresponded with iMiss 
-M.'htmgale about V^s desire to alter the nursing 
svstem m the Sydney-then the only large hospital 
•n the city That the early Nightingale nurses were 
a remarkable group of women is emphasised afresh 
by every recollection of them. In 191 1 , two Austra- 
han nurses were still living who had been trained 
under AIiss Osburn, and one of them said of her; 
Mie was an exceptional woman, well-read, having 
an absolute fascination of manner and an mdomit- 
able will. She looked upon nursing as the highest 
employment a woman could take up. ... To her 
It was a holy mission, and should be entered into in a 
spirit of devotion, ..." 

Within four years the five nursing missioner^. were 
scattered over Australia, doing pioneer work in new 
hospitals m other colonies. 

Five more Nightingale nurses were brought out 
by the Tasmanian government a little later and set 
to work in Hobart and Launceston, whrre'training 

• .1 Pioneer of Tratncd .\ur,c., p. 364, .\ovember, 191 1. 


A History of Nursing 

schools were, in time, established. Few of these 
nurses kept long to their original contre, their services 
being requisitioned by the new hospitals springinj.' 
up all over the continent. It was, therefore, the per- 
sonal work and infutencc of the Nightingale nurses 
that began organised nursing, and subsequently 
organised training schools in Australia. 

In October, 191 1, the Sydney Hospital celebrated 
Its centenary with suitable ceremonials and events, 
of which the one of most significance to nurse, was 
the endowment of a bed by nurses past and nresent, 
for sick members of their guild. 

In 1 87 1, ivliss Haldane Turriff, one of the first 
Sisters of the Sydney Hospital, and a Nightingale 
nurse, was asked to take the matronship Oi the then 
new Alfred Hospital in Melbourne. This was one 
of two built to commemorate the visit of the Duke 
of Edmburgh to Australia, the other, the Prince 
Alfred, being in Sydney. Roth have become im- 
portant and valuable training schools for nurses. 
The former enlarged and improved its training in 
the eighties, under the administration of the medi- 
cal superintendent,. Dr. Backhouse, the nurses' course 
being lengthened to two years in 1887. Under 
the matronship of Miss M. D. Farquharson, an 
English nurse who was at the luad of the .srhool 
from iS(>o to i8(>.s, it was lengthened to three years. 
Miss Farcjuharson stood on the Council of the In- 
ternational Council of Nurses from its inception, 
representing the Commonwealth of Australia. 

The Prince Alfred Hospital in Svihu'v, wliieh is an 
especially well-ecjuipped and up-td-d.itr institution, 
owes much of its prestige to \lw l.»ng service of Miss 

Il New Continents 


S. B. AIcGahcy, as Lady Superintendent, there. 
Unrin- the time she was conneeled with it .she made 
a tour of the world, coming on the way to the Con- 
grc-s <;f Nurses in Buffalo, U. S.. and" taking hack 
all the best ideas then available as to ho-pital con- 
struction and fittings. 

The Melbourne Hospital, which underwent re- 
huiKhng si.xty-odd years after its foundation, opened 
i*s do.jrs in 1X48. its sole resident stafT being an 
apothecary and a Matron. For many ycars^the 
Matrons of this institution were only housekeei)ers, 
and, when the increasing number of inmates called 
f..r more attention, the staff was purely domestic. 
A in all Australian hospitals of that (lav, nurses' 
duties consisted in feeding the patients and kcrj;- 
ing them and the wards clean. Almost all, even the 
most elementary details of nursing, such as taking 
temperatures and giving medicines, were carried out 
by the medical stall. The founder of the training 
sli'ul in the Melboume was Miss I. J. Rathic, an 
f'Miiiburgh Royal Intlrmary nursi', wlio came from 
n.'l-art to the Melbourne in 1890. She brought 
•'•! il her two certificated Sisters, who assisted her 
in organisation, at;^^ Rathie was followed after 
tive years by Miss Fanjuharson. who was the first 
'lere, as she had I)een in the Alfred Hospital, tt) give 
'hr nurses theoretical as well as practical in ^truet'iMn. 
Th'y- appreciated it intensely, and Miss FarquJiar- 
"n's ten years' service in these two hosjiitals did 
■ '!''i lo set the high standard of professional in- 
'ruction demanded bv -Xuslralian nurKe:; 1o-dny, 

MissWeedon from tlie diaring Cross in London 
^vas the first trauie<l Matron of the Brisbane Hos- 


A History of Nursi 



pital. She established llic training school in 1885, 
and the first certificates were ;4ivcn in i <ss.S. Pre\-i()us 
to 1885, nursing in Uueensland was vitv ])riniitivc. 
There were few nurses, if any, wlio iiad had the 
advantage of regular training. 

In Adelaide, the (leneral Hospital was, until tlie 
year 1886, under the management of a housekeeinr. 
In that year, two ladies trained in the Londdn 
were apjjointed as day and night sui)erintendent;-, 
and a training school was opened there. About i^H(y- 
'88, regular organised training of nurses was e^taii- 
lished in most of the metropolitan h()S])itals, ard 
certificates given. At first there considerable 
difTiculty in obtaining sufticient numbers of suitable 
probationers, and in some i)laces it was even found 
necessary to advertise for them, 'i'here was a stronj,' 
feeling against the name of the trained nurse, and 
of course the necessary I'hanges in hospital adminis- 
tration met with tiiuch criticism. Ther'' are stttrics 
still toUl of medical men who were openly opi)osed 
to such a dangerous practice as the training of nurses. 
There were many diflicidties to be faceil and much 
hostility to be put up with, but the courage' and en- 
terprise ot the ]iromoters of tlie movement were no' 
to be quenched by any amount of wet-blanketing. 

Each town of any size has several hos])itals, includ- 
ing those for eliildr(>n, for infectious diseases, and for 
midwifery. There are aL-o hospitals for eye and car 
treatment and t"or the tn.itinent of disease^. 

Ilospital training has naturally ch.angid in many 
ways since the training school movc^nent began. 
Originally nurses' bedrooms and board were of tlie 
plaiiK'st and roughest description, and their h;>urs 

In New C 



were very long. The duties required of then, in- 
cluded a vast amount of housework, which exhausted 
their strength and devoured their time in a most need- 
le-- ^^ay. By degrees ward mai.Js and housemaids 
v.vrc mtrodured, thus relieving the nurses of mueh 
inirely domestic work; more men were employed 
as porters, and nurses were no longer subjected to 
the harmful stram of carrying heavy patients and 
m.n-ing lurmture. The older hospitals have been 
niher remodelled or rebuilt, and modern labour- 
saving contrivances, lifts, etc., have been used All 
thi^ with the increased comforts in nurses' homes 
!;. • the life of the pupil nurse mueh less trying' 
-"•Has now more time to devote to mastering the 
mtncaces „f her profession. .\Vw duties and fresh 
rosponsib.litics have b,,,, laid upon her. and she 'is 
anmeh more highly trained woman than her sister 
"' -he eighties and early nineties. 

'Hu' general management of nursing education 
••■_■' rubhc affairs concerning nurses is in the hands 

o| two governing bodies, one. the Australasian Trained 
Aunses Association, having its headfjuartcrs in 
^y'-ney. while the state of \'ict„ria has its Roval 
W-tonan Trained Nurses' Association. There "i. 
hosides these, a branch of the Roval British Nurses' 
A>sociat,nn in South Australia, which is in close 
■^ '' ^vith gcncnd tuirsitig ntLdrs. The Councils 
- the Australasian an.l \-i..,nrK.n associations are 
imposed of me.lical men and members of the nnrs- 
^'1^' profession. There are rej .resent at ives of the 
I^itrons of hospitals, of the nurses tlumselves and 
;•' nal representatives of the special training schools 
> Id the subcentres. 

«"t. IV,— I a 


A History of Nursing 

Of the beginnings of the Australasian Trained 
Nurses' Association, Miss AIcGahey reiwrted, at the 
Buffalo Congress, that, as early as 1892, a meeting of 
medical men and nurses had been held in Sydney 
to consider what steps could be taken to form an 
association in that city, but so great was the diversity 
of opinion as to what constituted a "trained nurse" 
that no agreement could be arrived at. We next 
find that, in 1894, the Matron of the Launceston 
Hospital in Tasmania, Miss Milne, came over to Nev/ 
South Wales to confer with the Sydney Matrons upon 
the possibility of starting a nurses' association. On 
her return to Tasmania she tried to bring about the 
plan discussed, Init soon found the time was not 
opportune. Miss Milne's keen interest in the social 
and educational progress of nurses induced her to 
consent to act as honorary \'ice-President of the 
International Council of Nurses representing Ta.-^- 
mania, in which position she stood for international 
relationshii)s and i)rofessional union. A few years 
more brought success, for the small band of leaders 
was not to be daunted, a'ld in i8(;() another meeting 
was luld in Sydney, New Soutl; Wales, and that 
association was founded which, at first, was named 
after the cohmy in wtiieli it arose, but a few months 
later, because of its nieniher.^hip from all colonies, 
was given the comiirehensive name of The Austral- 
asian Tramed Nurses' Association. Amonj, the 
objects agreed urion at its inception was this one: 
"To establish a system of registration for tr\iiie(i 
nurses." The Lite Dr. N^mIou Manning was cho.-en 
as its first president, and Miss MeOahey and Dr. Mil's 
wen> made honorary secretaries. They '\orke(I most 

In New Continents 


enthusiastically at the general arrangements, and 
very soon evolved regulations so broad and so suit- 
iihlc that to-day, twelve years later, there an^very 
!. '.v alterations, and these same ruli's govern the 
training and registration of nurses thro"<^hout the 
length and breadth of the continent. 

The Royal Victorian Tn.ined Nurses' Association 
ua. inaugurated in June, 1901, with Dr. J. W. 
Springthorpe as ils first president. The association 
v.a< fortunate enough to remain under liis guidance 
until 191 1, when he retired, and Miss Ayres, ^Matron 
of the Alfred Hospital in .Melbourne, was elected i)rc- 
sident. This was the first time in the history of either 
oi the Australian associations that a nurse was 
elected as presiding officer, and the event was com- 
nn-nted on in the nursing journals with general ap- 
iirohation. The British Journal ofXnrswgsaid of it: 

The selection of Miss Ayres may be looked upon as a 
VTv happy aii-ury fur the future status of nursing in 
\uiona. Of Miss Ayres's professional work il may be 
siKi that no one has done more to raise nun -'ng to a hi^h 
standard than this lady, who. as the senior Matron in 
Melbourne, i. bd^ued and respected throughout ilie 
:'^'''- Abss Ayres was one of the original founders f if the 
iv' Victorian Trained Nurses' Association, and has 
worked loyally and elTectively for its success. 

The two associations entered into a rccii)rocaI 
agreement in March. 190J, and local councils of the 
Australasian Association were gradually established 
in Oueensland. Souili Australia. Western Australia, 
and Tasmania. Kach council is in-,-,, i u;,lh- a self^ 
governing b(xly, only certaiTi points, mostiv inter- 

I bo 

A History of Nursing 

prftalion of rules, being referred to tlie Central 
Council. The various eouneils all work with the 
same rules, and alterations to existing rules are 
reterred to all states before final deeision. 

The purposes and methods of the two ruling Aus- 
tralian associations are exeeedinglv interesting and 
worthy ot eaivful study, while the results tliey at- 
tained are unicine, for in no other eountrv ha< a 
voluntary association of nurses— or of i^hysieian. 
aiKl nurses-succeeded in imposing an educational 
standard on hospitals to the extent and de-^^rec 
witnessed in Australia, without state registration 
and simj,]y by the force of its membership regu- 
lations and oversight of the whole nursing field 
Through the two associations, working reciprocally 
the training schools throughout the continent have 
l)een brought into line, and by means of a central 
examination f<ir membership, held everv six months, 
a high uniform standard has been attained Tin' 
minimum length of training has been fixed at thn 
years in hospitals with a daily average of over forty 
occui)ied beds: four years for those of over twenty 
beds, and five for of over ten. K ac h hospitJl 
recognised by the associations as a traj'ning schc-J 
agrees to abide by the .schedule of training laid da^vn 
by the associations, and sends in to them annual 
reports of the progress of each pui)il or nurse in train- 
ing. In this way tlu> Council keeps in touch with 
Its future members from the dav they send in their 
papers to the ICducational Committee; for ev( ry 
candidate for hosintal training has to jaoducv evid- 
ence that she has attained to a certain standanl of 
education, and. failing .such evidence, haa to )V'iss an 

In iNcw Continents 


examination to prove that she is sufficiently equi]jijcd 
as tar as English and arithmetic are concerned. 

In much the same manner the training, preliminarv 
educational test, and final central examination o'f 
obstetric: nurses sc king membersliip is controlled 
ly the association. Throughout Australia the time 
nt hospital tram^vii in this specialty is twelve months 
except in the case of general-trained nurses, who may 
'inahty for an obstetric certificate by six months' 
training in a recognised obstetrical training school. 

In loii, the Australasian associations added an- 
other branch of nursing under similar rules, namely, 
that of mental nursing. For this specialty, a three 
years' training in a recognised government hospital 
tor mental cases of not less than one hundred beds 
:■ -'(luired. Should registered mental nurses wish 
..^•■Twards to train in general nursing, their mental 
o rtihcate enables tnem to start in the second year 
ot a three years' training school, the theoreticafand 
practical tuition being on the same lines in both 
da.sses of hospitals during the first year. The as- 
sociations provide for the registration of nurses hold- 
;nk' general hospital certificates, also for those who 
|-o!d. in addition, certificates of special training. 
In>tructinn in invalid cookery is an essential jiart of 
the gcnernl t raining. Xcarly five thousand members 
belonged on tlie rolls ,,( th,. two associations in 
""" M. tju'se numbers showing what a power they 
!-'>e made themselves. 

Xevertheless. in spite of the unusual power and 

mOuence gained over hospitals in specific points of 

educational nuiuirements by the associations of 

• V.O, aiiu ueoj;;;L- uie iCsuiis gauiew u)' voluntary 


A History of Nursing 

registration, far surpassing those aehieved under 
voluntary auspices in onv other eountry, the nurses 
and medical men of Australia came gradually to the 
conclusion that they must have the interference of 
the state in order to cope successfully witli those 
institutions whose own standard as to education, 
or convictions of self-interest, clashed with the public 
good, as such centres could not be reached by the 
means available to a private society. For some years 
the growing evidence in this field occupied the minds 
and meetings of nurses. In April, 1906, a conference 
between delegates of the two associations was held 
in Melbourne, where many matters of common in- 
terest were discussed. Again, in July, 1909, a second 
conference took place in Sydney, and was attended 
by delegates from all the states of the Commonwealth 
working under the Australasian Trained Nurses' 
Association. One important subject discussed was 
the necessity for state registration, which was un- 
animously recognised as pressing. 

To provide for this reform, a bill was prepared and 
introduced by Dr. Mackellar, to whose unselnsti 
labours in its behalf the gratitude of the nursing pro- 
fession is due. Among the deputation which waited 
upon the Minister of Public Instruction in the New 
South Wales Government were Miss Kendal Davies, 
Miss Gould, Miss Newill.Mrs. Ashburton Thompson, 
and Miss Sanders, as well as a number of physicians. 
Of the outlook for success the Australasian Niirsci 
Journal said in May, 191 1: "There seems even.- 
probability of having state legistration of nurses in 
N(>w South Wales by the end of the present year, 

iudf'^ini' bv the fnvnnrnhl rf>r<pntir>n ^n,'r\rA(^A hi- A 

■J. H 


In New Continents 

I S3 

nim ster of the Crown to the deputation of the 
Australasian Trained Xurses' Assoeiation." This 
bill was passed in the Ui.per Ilotise, but before i. 
-vnt farther (Juectsland eanu- to the front In 
"'■I Its .i^^ov-rnment an,en,!ed the Health Aet and 
nurses were takc^n by surprise to fin.l that son^'e in- 
efficient elat^es were being added, providing for 
K,.strat:on. 1 he Queensland Couneil at once c'lled 
a speeial meeting, and the wishes of this i^rofessional 
- y were submitted to the ministers, with tlte result 

at all their amendments, exeept two, were aeeepted. 
On January r, uji2, the aet went into effect. It is 
omsidered by the nurses fairly satisfactory, and they 

.11 keep a close watch upon its administration (if 

tfi's event Miss Garran, secretary of the A T \' A 
said: ' ' ' 

Under Australian conditions there are certain .^rcat 
advantages in the work of registration done h> the 

the present system of an independent body, which 

hyu.h .t receives government siip,.ort and ap ;ova i^ 

- free from political influence. With our uniform ^y.s^ 

Uin of trammg. examination, and registration, we arc not 

o urgen ly m need, of state registration a., in a eoun? y 

kre^hfr " ""^'; '"^"^^'^' '^ "^ '''^^^- -^^" itself"; 

from on^T '' "';' ?T"" "^ registmtion and one standard 
rem end to end of the continent. State registration will 
o a great extent break up this uniformitv. as each sti e 

will have Its own law on the subject. The aim of the 

.hi 1 k ■• ; '\ T' '"""'■'"'"' '° ^'''' "^ ^"y ^tate where 

I Iro 't ":'":' •'" '''' ''^"^ P'""^"^^^ '^^'^''^'tion mav 

i,! T:^!'"^'^ '"?^^''">^ ^-^^h our methods and stand"- 

• , :.u. _^;c; ^re uuuuu io oc many and great differ- 


A History of Nursing- 

enccs in the laws passed by the various parliaments and 
in the reoulations and by-laws passed by the local govern- 
ment boards. . . . 

The tendency in Australia— a tendency which has 
increased durin- the years that women have had the 
suffrage— is for men and women in all political, social, 
and professional associations to labour side by side at 
the work in which they are mutually interested and not 
to separate into opposite camps. This is especially the 
case with nursing, where, whether in hospital or in private 
work, the one cannot do without the other; and, indeed, 
f- im all I can slather from Australian nurses who return 
from their travels abroad, it seems that doctor and nurse 
work toK'ether on much more equal terms here than is 
the in most countries. Certainly the medical men 
in Australia ha\-e worked hand in hand with the nurses 
to raise their professional training and status. 

Two professional journals are published monthly 
in Australia, the Australasian Xurscs' Journal be- 
ing the organ of the older society, while Una is the 
periodical of the Victorian nurses. They arc keenly 
alive on educational matters, giving much space to 
reports and diseus.sions relative to the enforcement 
of their standards upon hospital training schools, 
and publishing fully the status of the various institu- 
tions from this point of view. They follow the eco- 
nomic circumstances of nursing with close scrutiny 
and clear vision, never losing sight of the need for 
keeping a good standard here as well as in education. 

Private nursing is ^he branch which accounts for 
the largest number of nurses on the register. There 
is abundance of work during the greater part of the 
year, the demand for nurses at times excGedinp the 

In New Continents 



supply. Private nurses are usually attached to a 
nurses' home. These homes charge a small weekly 
fee, and act as agents for the nurses, providing ihem 
in turn with cases. When they are in residence in 
the home, moderate board is also charged. Nurses 
belonging .0 the various iK.nies are under the direct 
protection and guidance of the lady supenntendent. 
Private hospitals which are registered by the as- 
sociations are pledged to employ only certificated 
nurses on their staffs. It is, therefore, now impossible 
tor patients who pay for skilled attendance to be 
Kft to the uncertain ministrations of the partially 
trained nurse. 

It has long been evident that a considerable portion 
ot the community was unable to face the ordinary 
nursing or private hospital expense, and yet not 
prepared to ask for treatment at the public hospitals 
In consequence of this fact, much attention has been 
Kiven of late to the question of the nursing of the less 
well-to-do. At the time when this is being written, 
some scheme for providing an intermediate hospital 
IS being discussed in connection with the Friendly 
and Provident Societies. ' 

The nurses themselves have, to some extent 
grappled with the problem, and have instituted 
visiting or hourly nursing. Much good work is 
being done, many sick folk being thus enabled to 
receive skilled attention in their homes, who otherwise 
would go to swell the hospital lists. It has been 
f'"ind possible also to overtake a number of cases 

■ The.e intcnnediatc hospitals would probably receive patients 
WIH' eouM pay a small reasonable sum ocr week-. ... k c, ,..;^„i„ „.... 
li'inary m American hospitals.— Eu. 

1 86 


L History of Nursing 

where some attention was required, but where 
the members of the family were Cjuite capable of 
aitendin- lo the patient, once the important details 
were seen to by ihv nurse. The visitinK nurse is a 
boon to the tired nurse with a heavy ease, to give 
assistance with especially difltieult procedures, or to 
relieve the nurse, in times of stress, for exercise or 
sleep. She has been uell \sGrth her small fee, and 
has, in some cases, saved th.e patient the ex])ense of 
a second nurse. District nursing does ver^- similar 
work in po. -er circles, and it would be impossible to 
over-estimate its worth. 

_ "Bush nursing" is in its infancy, but it shows 
signs of lusty heaM'. a i rai)i(] development. Bush 
nursing means, in Australia, what rural nursing means 
in other countries: It is intended that no settler 
however remote, no little home, in however distant 
and lonely a part of "the bush" it may be foun.i, 
shall be isolated beyond the possibilitv of skilled 
nursing care in time of need. Bush nursing is a bij: 
scheme and calls for much forethought and can lul 
adndnistration. Enthusiastic women, old enough to 
be experienced, yet young enough to be adaptable, an 
needed m i]\\ positions as bush nurses; above all is 

it of the first imp( )rtancc that nurses undertaking such 
work should have had tlie lulK-t . most thoniu-h.must 
well-rounded training their country- is able to 
give them, both general and special, for such women 
must be, in tJie widest sense, missioners of health as 
\\( II as nurses of the sick, and they should be the 
very flower of th. ir imtession. This principle has 
be(>n rocogniscfl in the high standard of qualifications 
demanded for nurses entering this .service in .Australia, 

In New C(3ntinents 


and it may be concluded from the history of current 
cv. nts that the power of the professional associations 
ot the country was successfully exerted to secure a 
model i)attern for the equipment of the bush nurn^ 

1 he Countess uf Dudley has placed the Common- 
v-ahh in her lasting obligation bv the sj^lendid 
work she performed, in spite of much <h-m<.,ltv in 
orgamsmg bush nursing. Others have helped, son^e 
with generous gifts of money-among these Madame 
Melba-but It was Lady D.ullc^y's keen interest and 
unlirmg, enthusiastic work that began bush nursing 
•n Australia. It had l^vn her hope to establish it on 
a federal scale, covering the whole country in one liar- 
monums network, and in the planning wuh this aim 
in ^■K•^v^ Miss Amy Hughes. General Superintendent of 
the Oueen •■ Institute in the mother country, had been 
•-■ailed to Australia to confer and counsel The large 
^ '.mti syscem. however, was not destined to spring 
'^>ll-iledged. and nursing began under state 
^msp.ces. the first nurse bemg installed at Beech 
i"rest early in .9,,. From this begnnning it will 
|vithout doubt, spread from state to state. Tasmania 
las been making efforts to provide bu.h nurses for 
he many islands grouped about her These islands 
have been for months in the year imable to obtain 
cither medical or nnrsitig assistance. 

Medical inspection of school children is enforced 
throughout .\ustralia. It, Ilobart a nurse has been 
appomteu :o assist i.i such work, which will dM„h;less 
'Hvome more highly perfected and demat>d m.rses 
"1 large numbers, providing a new oi)cning for capal)Ie 
«^';men as well as ensuring the well-being of school 


A History of Nursing 

Lady Talbot has also left Australia a inomento of 
her work for the sick and afflicted in the 'i albot MiJk 
Institute which she inaugurated during her husband's 
term of ofhce as State Governor of \'ictoria. By 
means of this charity jjure milk and ice are supplied 
to delicate babies. Two nurses are employed in 
connection with this institute, and their oversight 
an(i educational work, aided b}- the suflkient supply 
ot i>r,re food, has meant health and strength to many 
a inmy, delicate child of the stifling back streets. 
Numbers of little lives mu^* ^^ve been saved hv 
the Talbot Milk Institute. 

In some centres nurses are emi^loyed as sanitary 
mspcctors; while at least one insurance cor i pan v 
IS using a^ nurse in investigating and caring for 
"sick-j)ay" cases. 

Nurses' clubs are being talked of cvcr\^whcrc. 
Though fi'w have as yet come into existence, the need 
is felt, and very soon every centre will follow the 
example of Sydney and have its own club. This 
will do great good, for tiie social side of nursing life 
might with advantage be improved and developed. 
Australian cities are -aid to be too lavishly sup- 
I)lied with institutions U>r the relief of the sick poor. 
It is claimed by some that the work could be done 
more conveniently and .n nuuli less expense of time 
and money, were the many merged in the I wo or three- 
While there is much (hTferenec of opinion on thi 
point, it would undoubtedly be of advantage to the 
student of iiursinR to be able to take her special 
courses in her original training school, instead of, as 
at present, waiting admission to another hospital. 
There are rcgi.stcrcd training schools in all the 

In New Continents 


larger toums of the states, while in the small eountrv 
t.nvns there are cottage hospitals whitli are often ver^- 
well Iniilt and ui)-to-uate as to their ecjuipment. 

With regard to the untrained nurse, she is with us 
i;i large numbers, continually exemplifying the truth 
of the^saying-"A Hale knowledge iJ a dangerous 
thing. In midwiferv- practice especially she n'ay be 
described as a danger to the comm.unitv. But the 
day is at hand whdi all midwifery nurses working in 
Australia will be required to jjass a state examination 
and be registered by tlie state. 

Much has been done in every wav. during the i-ast 
twelve years, by the two leading associations, but 
no record can give the tnie value of the work done 
hy many individual women in the earh- days. To 
the Matrons and .^isters of our ho.spitals in the" various 
states is due the advance from (hat tinu- when igno- 
rant and uneducated women, many of whom cl.uld 
tiot even read and write, staffed our ho-^juials, to the 
present satisfactory state of nursing j)rogress. The 
true history of Austrah'an i.ur.-ing is the stor\- of the 
lite-work of man_\- honourai)le women. 

New Zealand. New Zealand is one of the young- 
est of Crcat Britain's daughters; discovered in ijU) 
by Captain Cook, she was not settled for manv vears 
later. Tlie liistor}- of the care of her sick in early 
day.s IS fragmentary, and few records arc reliable 
unul the times when, population becoming more con- 
centrated in some centres, the different provincial 
governments found it nccessar>- to provide hospital 
accommodation for the peoi)le. There was no settled 
system of nursing, nor were there trained nurses. 


A History of Nursing 

The Auckland was the first hospiial estal)hshcd, 
the city of Auckland being the seat of government 
for the \orth Island. A site was set aside in 1830, 
and the ])atients now partaking of the benefits of 
the hospital have to thank the ofificials concerned 
for their choice of a most lieautiful sjjot. The large 
area of land chosen is on a rise commanding an ex- 
tensive and most lovely view of 'he h:irbour. Here 
a small building was erected in i.S^o or 1851, no part 
of which now remains. It was designed by the Rev. 
Mr. Thatcher, private secretary to Sir George Grey, 
and had about ten beds for each sex, with living room.-^ 
for the -Maste \ Matron, but no room for a resi- 

dent j)hysiciai Tnere were no female other 
than the Matron. Dr. Mackellar was the first medical 
officer. The hospital was managed by the provincial 
governn-R'nt until the abolition of ])rovinces in 1875. 
At that time a stone building was put up which forms 
the nucleus of the present large hospital. Up to 
18S3 it was under government control, wht^n it w.'is 
placed under a .'()mmittec in part nominated by the 
governor and in i^art elected by the sub.scribers. 
A government insi)ector was then api)ointcd to super- 
vise all hospitals. This was Dr. (Brabham. His 
first n port describes the nursing in this institution 
in 1S83. 

The female nursing (which is confined to llie hryv. 
ward for females and to the female fever ward) is per- 
formed liy the Matron, an assistant nurse, and a ni^Iit 
nurse. The Matron takes her meals in an adjoiniIl.^' 
room, but sleeps at home, as also docs the night nurse. 
In this division of the hospital the patients appeared to 

In New Continents 191 

be well and kindly treated. Evorythin, wa., n.oreover 
orderly and very < ■^.an. I cannot, however, approve of 
tn. arrangement whereby at present the an nu ses 
attend np,>n th. ordinary pat.ents and those suZn,! 
from fever. The same tlnn. is don. when searlet f.ver 
... present. The male fever ward has nine beds; e ^h 
o h.s. are oecupu.! by typhoid fever eases, and fhe 
other hy an old patK-nt, who does the whole of the 
nursm,. At present he has some assistance fron. a con- 
valescent pat,ent, and he certainly does everything in 
I"^ power for the j^ood of under his char.e The 
ward he keeps beautifully clean also; but the arrange- 
ment IS a very bad one. and may end in disaster The 
nursm,-jf J naay call it by that namc^in the other 
male wards ,s of the most wretched description. In Ko 
1 .here is an oKi man. who is paid to take charge of it' 

,h"'K 'f r "r '^'" °^ ^"°'^^'" "''^ "^^"' l-'^'^^^-ht from 
the Refuse for that purpose. ... 

The comniktee tlten ai)pointcd a trained nur^c as 
supenntcndcnt and made Dr. E. I). Mackellar 
resident house surgeon with quarters in the bmldinL- 
in Mte inspector's next report, wntten in ,884 he on the improvements made since his former 
v-isit. and his satisfaction with the manner in which 
the committee and medical officers of the Auckland 
and other ho.^pitals had received and carried out his 
suggestions. He then .said: "\Vc have now many 
establishments which, in thei^ arrangement:, order 
and comfort, will bear favourable comparison with' 
any of the European hospitals with which I am ac- 
quainted, and a spirit of emulation has .sprung up in 
the Colony which cannot fad ,0 have a wholesome 
I crtect. He it"c . on to s.-n- tli-.t o ,.„_. -,---11 . 


A History of Xursincr 

system of nursing is in full operation at the Welling, 
ton and Cliristchurrh hospitals, where well-educated 
ladies may be seen sf-ving their apprenticeship with 
other "probationers." There were, however, ap- 
parently no regular training schools yet initiated. 
Miss Cris]) is specially mentioned as possessing 
"in an eminent degree the qualifications which 
are desirable for her present position, and is ably 
seconded by her assistants." 

Miss Annie AHce Crisp, the new Lady Superin- 
tendent, was a certificated nurse, trained at Xetley, 
and had been in active service in Eg\-i)l. On her 
appointmcni Dr. Mackellar recommended a staff of 
women nurses for the men as well as W(imen patients. 
At this time the number of beds was— male, seventy- 
three; female, twenty-seven; no children's beds. 
Miss Crisp had as staff twelve nurses, two house- 
maids, three jjorters, cook and assistant. Five years 
later the training school for nurses was established. 
Dr. Mackellar took the greatest interest in this work, 
and even now he is looked up to by Auckland Ho.spi- 
tal nurses a,, the father of their school. Long after 
retiring from the position of medical superintendent 
he was an active member of the honorary- medical 
staff, and still carried on the lecturing and teaching 
of nurses which he inaugurated. 

The modern Auckland Hospital is a fine and up-tc- 
date institution of 340 beds. Attached to it and in 
the same grounds is a well-designed infectious anni'.x, 
comprising two observation wa'ds for suspicious, a building for scarlet fever, with two wards, 
nurses' quarters, and offices, and a similar one for 
diphtheria. There are a fine laboratory- and a mor- 

In New Continents 


tuary in one building, and the hospital proper is 
built in blocks erected at diilercnt dates. Every 
ward has wide balconies to which the patients are 
wheeled to enjoy the beautiful view of tlie harbour. 
The new wards are known as the "Costley Block"" 
f:om the name of the wealthy citizen who gave the 
tunds to build a theatre and surgical wards for 
cnildren. A large addition to the nurses' home is 
al.o new. The nursing staff is under the control of 
a lady superintendent, who has under her an assist- 
ant in charge of the home, where eighty nurses are 
in training. The course is for three years, and 
a very complete set of lectures is given by members 
01 the staff, resident medical officers, and superin- 
tendent. The ward Sisters give the practical 

Under the control of the same board are the Costley 
flome for old people, with a trained nurse in charge 
ot the women, and a convalescent home, to which the 
hospital nurses are sent for short terms. 

There was at one time a ward for maternity 
patients at the Auckland Hospital, and a good 
many nurses learnt maternity nursing there, but this 
was discontinued some years ago. The nurses have 
a good opportunity of experience in different branches 
of nursing. The probaiioners are given their turn 
m the infectious diseases' wards as juniors and again 
as .seniors. The .special children's ^^ard takes in 
quite small babies and affords good experience in the 
diseases of children. One hundred and forty nurses 
have been trained and registered in the Auckland 
Hospital since "The Xurses' Registration Act " was 

I passed. The Mat- 

- -i-.- c:at_\.ecucCi i'.il 

Vol. IV. — ij_ 


A History of Nursing 

(afterwards married to Dr. Mackellar) were Ivliss 
Squire, trained at the Edinburgh Infirmary, who was 
appointed in 1895, and resigned after three years; 
Mrs. Wooten, trained in the Alfred of Melbourne,' 
who remained till 19 10, when she was succeeded by 
Miss Peiper, trained in Invercargill Hospital and 
Matron for some years of the St. Helen's in Auck- 
land. Miss Peiper was one of the nurses who went 
to South Africa to nurse in the Boer War, and she 
obtained her midwifery certificate in London. 

The Wellington Hospital has the honour of being 
the first training schocl for probationers. In Dr. 
Grabham's rei)ort of hi.; visit of inspection in July, 
1883, he mentions that ' Dr. Hammond has been ap- 
pointed Medical Officer and Mrs. Moore, Lady Su- 
perintendent. The 'nuises' have been supplanted by 
probationers drawn fro.n a higher order of society.'' 
He speaks of the need Tor better accommodation "for 
the nur .ing staff: 

The lady superintendent should have aportmcnts in 
such a position that, while within call, she would at 
tiTTies be free from the noises, bad smells, and other con- 
comitants of a residence close to the door of a larKc ward. 
The very successful introduction of the probationer sys- 
tem will also necessitate ..^me structural additions of an 
inexpensive character. These nurses take tlie greatest 
possible interest in their calling, which they have cho.sen 
from other than pecuniary motives only; and I no 
hesitation in stating that a .oundation is here Ix-ing laid 
for a considerable permanent benefit to the Colony. 

L.-iter reports by Dr. MacCregor refer to the im- 
provement in tl:e nursing stafl of the liosv-it.-d -nH 

In Nov Continents 19. 

especially mention Dr. Ewart («-l,o was for about 
tucnty years medical superintendent, reunng trom 
he pos,t,o„ only in ,yoSJ, and .Miss Godfre; vh" 
ramed under Mrs. Moore, bccan.e Matron ,n ,;,;' 
and ret,red m ,S,>S. being succeeded by M S 
Payne who had been trained in thehospitaf unde 

J TronrfTh'n"'",""''^'™-^^''-^ '°' -^•■°« 'ine 
Matron 01 the Chnstchurch Ho.,pital. Miss Payne re- 

n.amcd m oflice unt.l ,903, u-hen .she left to take 

harge of the Rotorua Sanatorium, and was succeeded 

by -M..SS Pettit, but afterwards returned .0 her 

ormer post n tyoj, great improvements took pla o 

auhrs hospna , m the opening of a fine nurses' home 

^..d specai chronic wards. The Victoria wards' 

accommodatmg forty pat.ents, are detached, and are 

co„,,lete hospual in the„,selves. There are sh< 1- 

trs forconsumpt.ves, and a new fever hospital with 

..own complete nurses' home under the sime man 

a^enunt as the Welhngton, though some d.stan:^ 

Several of the Matrons of the n.ost successful 
trammg schools, as Miss Thurston of the Chri 
c ureh Hospital, Miss McKenny of „„,' , ■ 
Miss Berry of Xapier. Miss Todd of Timaru M ' 
.« mg o, >-elson, and Miss McGregor of Waihi re 
lU'llrngton nurses. ' "^ 

The C, ristchurch Hospital was first built in 186, 
There bad bc.„ a small ho-spital previously at Lntdi 

hrst med,c.-,l ofl.cer, but there is no mention of a 
""rsmg staff. For about twentv years "he lid 
Chnstchurch was carried on under a l«,: ^:^::!^ 
' """'^^-'Ver. There then some women 


A History of Nursing 

nurses, not trained, but who were probably of a higher 
class than the servants, as it is mentiunLxl that they 
took their meals in their own rooms and that the 
patients were kindly and carefully treated. A ])art 
of the building erected for twenty-five i)atienis in 
1862 still stands, and in it are the disjocnsary and cut- 
patients' department. The wards above were used 
as lumber rooms for many \-ears. when, after a fire 
that destroyed two wards, they were again ])ut into 
use for the patients thus turned out. Tlie modem 
nurses thus learnt something of the di>.advantages 
their predecessors had to labour under In 1885, 
the first trained Alatron was ajipointed. She was a 
Miss Paion, who had been for six months in a 
London hos[)ital. Nothing more is known of her. 
The number of beds was then eight}-. Xo attempt 
at training probationers was made until i.S.S;. The 
chairman tlien offered a gold medal to the first nurse 
who trained there, but there is no record as to who 
received it. 

Two years later, we read that "the nursing system, 
one of the most essential features of hospital manage- 
ment, is well organised." Later the reports are not 
quite so satisfactory, as the h(xise surgeon needs to 
insist that all vacancies shall be filled with well- 
educated young women, cajtable of profiting by such 
special training as ever\^ modem hospital of tliis 
size ought to impart to its nurses. In 1S91, the need 
of a home for the nurses is dwelt on, and it is pointed 
out that, until this is provided, the staff cannot be 
put on a ]jroi)er footing of efficiency. It is re(-oni- 
mende-d that one be built and the- v.Ikmc nursing 
staff renr^raniscd. In rSo.i. cnv.M^ n iH^rio.d r-S *-.".;••-.!.- 

In New Continents 197 

Miss Maude, a nurse trained in the Middlesex 
Hospital, had been appointed Matron, and had given 
sj.lendid scrviee in reorganising the nursing of the 
:n>iitution, hut, unable to combat the prejudices 
engendered by the past system, resigned. She ^^■as 
followed by Aliss Ewart, then a Sister in the wards 
and trained in Belfast. After fourteen years sway 
Ahss Ewart was succeeded by Aliss Thurston, trained 
at the Wellington Hospital, who. as the head of nurs- 
ing m all the institutions under the control of the 
board, supervises, besides the main iK.sjntal, the 
sanatorium for consumptives on the Cashmere Hills, 
the chronic wards for women at the Jubilee Memorial 
Home, a mile or two away; those for men at Ash- 
burton, and the hospital for fevers. Trained nurses 
belonging to the hospital stafi are in charge of these 
outlying wards, and probationers are sent to them 
during training. A cottage hospital at Akaroa. a 
lovely seaside place, is also under the board and is 
staffed from the hospital. 

A new children's ward and one for gjmecological 
patients enable Christchurch to boast of posses'^sing 
the model wards of the Dominion. The children's 
ward is tiled throughout in pale blue and adorned 
with beautiful nursery pictures in tiles. The 
verandahs are uide, that cases may l)e treated in the 
open air. Convalescent children have a garden 
playground, and the women's ward a roof-garden. 

The Dunedin Hospital is the medical school of 
the Dominion, and its history has been of special 
interest on this account. Only sixty-two vears ago 
was the Otago settlement foimded and, two vears 
<^iler^vards, the hrst Dunedin Hospital erected. The 


A History of Nursino- 

Memorials of John A. Torrance describe its earliest 
days : 

Liko t he rrar)! it was in advance of its time. For 

over tu-o years not one <.f its beds was occupied,' and 
then also hke the ^-.uA, it was turned to a use never 
dreamed of. The insane persons had to be cared for 
an<l s,. the first Imspital became the first asvlum and for 
a tnne it served the double purpose . . . those physic- 
ally s,ck of course ultnnately preponderating. Buc not 
untd the discovery of the gold-fields in 1861, when im- 
nugrants werr poured into Dunedin by shiploads, was 
there any large demand for hospital accommodation. 

The hospital is now a large and handsome insti- 
tution, with well-cquippcd schools both for medical 
students and nurses. The training of nurses was first 
started in 1888, when lectures were given by the 
honorary- staff and an examination was held at the end 
of -velvo months. At this tim- 'he Alatron. Miss 
Burton, an estimable elderly dame still [in 191 ij hy- 
ing near the hospital and sometimes attending as an 
out-patient, was quite untrained. How her eyes 
must open at the appointments of the new out-patient 
department and the nurses on duty there ! When the 
question of giving lectures to the nurses arose, she 
said: "What do they want with lectures.^ ' / 7/ 
lecture tliem!" 

The time of training was first f^xed at one \ear 
and nur>es were only placed in the women's ward.' 
The first Matron with f.dl training was Miss Edith 
Maw, who came from England in 1892, hut was onlv 
m office for one >-car. In 1893, Miss Isabella Eraser 
trained m the Edinburgh Infirmary-, r.nmo frv,,., m.l 


In New Continents 199 

oournc to succeed Miss Alaw, and remained in her 
post for twenty years. She instUuted a three years' 
course and placed nurses in all the wards. La 'e 
addmons have n.ade to the ho.<pita! in al ts 
dcpar nu.ns. and it ]>as also sevoral dependent in 
^mut.ons for infectious cases, chroni. and „" 
tu-e parents, aU ot which are under the one n^ 
suij^jntendent and lady superintendent, and a^ 
Mafled from the main hospital. There are also 
several cottage hospitals or receiving ^^.ards in 
different parts of the district, with trained nurss 
n.m the general staff in charge. The Alatern"y 
of the Alemcal School is a well-equipped small 
six>aa hospual where the Dunedin nu ses recdve 

iiowever, is a dis- 

midwifer>^ training. This, 

tinct post-graduate course of ^x momhs'und'lr Uie 

^ame rules_ as the state maternity hospitals 

«^nbcxi. there are over fifty others in New Zealand. 
Mtn .cus runnmg from one hundred to ten. Some 
of these were established in districts which once pro! 

existence of gold mmes long since abandoned Thev 
are now httle more than homes for old people and 
refuges for disabled miners. 

The hospitals which train nurses are thirty, in 
all Some of the medium sized ones, as Wangamn 
Palmerston Xorth. Waikato, Timaru. Napier and 

staffed, and send out excellent nurses. With state 

registration, their training has come into line whh 

he arger hospitals, and i , often a nurse from one 

"■-""■'^ '•■•''■"" ''-'y'-'^ ^^"^e iisL of examination 


A History of Nursing 

candidates. The histon' of the ]\lasterton Hospital 
is interesting from the fact that its first Matron was 
a Nightingale nurse. Tlie original building, j)ut up 
in 1878, was paid for with funds collected by Miss 
Selina Sutherland, aided by a government grant. 
Miss Sutherland was a per.sonality \\ell-kno\vn for 
many years in Melbourne, Victoria, in connection 
with charitable work :md the care of destitute 
children. In the early ckiys before the existence of 
the hospital, because of her energetic efforts to get it 
for the district, and lier care of the sick and aflflictcd, 
she was called the Florence Nightingale of the Waira- 
rai)a. The first Matron, who had had some training 
under Miss Nightingale, was Miss Lyons, but she 
only stayed a few months, and then until 1897 the 
hospital was in the care of an untrained Master and 
Matron. In that year Miss Heath, a Wellington 
graduate, was appointed with two trained nurses as 
assistants, 'llw new building was opened in 1907, 
and is a good specimen of a modern country hospi*^al, 
as the old one is of the cottage hospitals of twenty 
years ago. 

The Nelson Hosiital is fairiy old. The jm-scnt 
building was i)ul u]) in 1S67, but a still oldrr one 
had Ixcn built before that by the provincial govern- 
m(Mit. It , first trained nurse was Miss Dalton, an 
linglishwoman. A ])hotogra])h shows her a com- 
fortable looking dame of eighteen stone, and it was 
once remarked of lur that .she did all the work that, 
in later times, fifteen were needed f( )r. Before 
retiring for the night she would ]>ut her head in at 
the ward door and call out : " Now ; any of yoti chaps 
want a dnnk? Because I 'm going to bed." Miss 


In New Continents 201 

M. Jones was appointed in i8fA3, and under her and 
Ur. Talbot a course of trainin- for probationers was 
nrst started in 1897. 

These bn.f sketches of the principal hospitals 
and their gradual evolution as training schools show 
how primitive for some years were the arrangements 
l'>r nursing the sick. The people in various districts 
built hospitals, recognising the need. In many 
country places it was indispensable to have <ome 
provision of the kind, as the men in this new countrv 
were mostly homeless, living in tents, andgenerall^ 
roughing it. The difficulty of taking proper care of 
theni when in the hospitals was gren'ly accentuated 
by the scarcity of women, and owing great Iv to that 
cause the systematic training of nurses was'not pro- 
perly begun until about twenty-five years ago and 
men were mostly nursed by men. In fact, in one 
Hospital it was found that the only nurse at night was 
an old man. who attended on men and women alike' 
The appointment of an inspector of hospitals for 
the government undoubtedly aided greatly in bring- 
ing about a more correct method of administration 
< Jn his visits of inspection he could observe the n^eds 
of each institution, advise as to means of bettering 
each and every part of the organisation, and. bc-ing 
a medical m.m experienced in the management of 
hospitals m the old country, the nursing department 
was one ir which he took great interest and was 
quahficd to advise and suggest. The first inspector 
UJr. Crabham) remained in ofhce only about thn«e 
and a half years, and was succeeded by Dr Mac 
'""gor. who carried on the work for twcntv years, 
^n iSOS. a great step in the interests of nurses and for 


A History of Nursing 

Lhe betterment of their training was taken in the 
ap])ointment of Alrs.Cirace Neill to the i)o.siti(jn of 
assistant inspector of hospitals and asykm^s. Dr. 
MacGregor liaving recognised that the numerous and 
deHcate question^-- affecting women which had to be 
dealt with in connection with the system of charitable 
aid, and the administration of hospitals and asylums, 
ought to be handled in the first place by a woman. 
Dr. MacGregor considered that Mrs. Xeill ccmi- 
bined in a very hi^li degree the ability, knowledge, 
and sympathy recjuired for this position. wShe was a 
trained nurse, having undergone training in London, 
as Grace Cam])bell, at the King's Cross and Charing 
Cross hospitals. She held a St. John's House cer- 
tificate for midwifery, and, until her marriage, had 
been lady superintendent at the Chiluren's Hosj)ital 
in Pendlebury. She had, therefore, special qualifi- 
cations for the post to which she was ap])ointed. 

After coming into office, and becoming thoroughly 
acquain'uMl with the varying conditions under whkh 
the patients in the dilTerent hospitals were nursed, 
and the ver\- uinniual standards of the nurses sent 
out from them, both Dr. MacGregor and his assist- 
ant recognised the advisability of establishing some 
means by which the training i;f nurses could be 

At first it was proposed to establish a branch of the 
Royal British Nurses' Association, and negotiations 
were opened with that body, proi)osing afliliatioTi. 
but these came to nothing, as the jxirent association 
would not agree to sclf-govcrnnirTit for the colonial 
branch, and, though it was to be seIf-sup])orting, all 
sub.scriptions to be sent home. Mrs. Xeill 

In New Continents 203 

was in England X899, and had an int.en-ieu- with 
some of the officers of the association, but reported 
that she saw no reason to expeet the sHghtest ad- 
vantage to New Zealand, or help in establishing a 
standard of efficiency. In fact, it was found that 
no sucu guarantee of efficiency was even then estab- 
hsnedby that association, and the founders of it ha<i 
already, disappointed, withdrawn from its ranks and 
were devotm.^ themselves to strenuous efforts to 
oblam state registration. It was thus decided that 
only the power of laying down laws for the prope 
trammg and exanunation of nurses under state 
auspices would remedy the existing evils. Dr Mac 
(.regor made the statement: "Nothing short of this 


Early in 1901. the government authorised Dr 
MacCregor to prepare a bill for the state registration 
nurses. No interference was contemplated with 
the right of>' person t employ whatever nursmg 

ablelil^rV ^'^"^ '"''"^ ''""''^ '"^ ^--g - -I^ 
able list of nurses properly trained and tested by 

state exammations The bill n-i<^,wl i . 

, , , . '"^ "'" P'l^-^t'd, but was some- 

v^hat altered during its passage through the house 
Members representing districts where the smaller 
hosintals were established would not agree to the 
minunum number ,>f b.ds for training sc-ho,,!. pro- 
I"-"l at hrst. viz.. 40, and th.-ugh sonu- hunt and should have luvn s^.tU-d. this was not 
I one and any general hospital which complied with 

Zu'^^t "^. ""''""'"^ '""^^ ^^'^''^' ^" '^'^' best of Its 
M '" ^"^?^'"''""^ '-■ ' 'i'-n in the .svllabus. 
• able to send its probationers ,n, f,.r •.,^.^.. 



A History of Nursing 

While in older and more closely settled countries, 
no doubt, it would have been more easily possible to 
limit training schools to those possessing a certain 
number of beds, it is certain that, had it been done 
here, and with so high a minimum as 40, many ex- 
cellent nurstis trained in some of the smaller hospitals 
would have been lost to the profession As a matter 
of fact, with ver\' few exceptions, candidates for ex- 
amination do not come from the very small hospitals, 
or do not take it until they have had su])])lcmentary 
training in the larger ones. \MK'n the act first came 
into operation, nurses who had been previously 
trained, or who liad had fi)ur years' experience, were 
registered, but after 1902, all New Zealand nurscs 
had to pass the state examination. Some of the 
larger hos])itals in which a systematic training had 
been carried out before this still held their own tinal 
examination, and gave a certificate -ndependently 
of t liat given by the government. Tliis is the correct 
thing, as nurses should value the certificate of their 
alma mater: but the smaller ones seemed content to 
avoid the trouble of examinations and leave the work 
to the government. The regulations as to examina- 
tions, and the curriculum of training and syllabus (if 
lectures, were drawji nj) by Mrs. Neill, and continuai 
in use for .several years without alteration. Tlicy 
were, however, in 1907, revised and altered, though 
it was not found necessary' to make any ver>- great 
difference in the main points. It is hoped later to 
amend the act in several details. Gspccially with 
regard to tlie recognition o( hospitals as trainiJij; 

We have gone thus fully into the institution of 

In New Continents 205 

state registration for nurses in Xew Zealand, as this 
Colony was the first of the Bntish possessions to 
iu:s a bill for that purpose.' After two or three 
years of operation, the inspeetor-general of hosjmals 
remarks m his annual report: "It is becoming daily 
more apparent that by the silent pressure of thi^ 
lajv the nursing profession of New Zealand will be 
erteetivdy organised." In the last report (written 
shortly before his death) of this able administrator 
of the New Zealand Hospital and Charitable Aid 
JA'i)artment, he says: 

New Zealand has proved by five years' experience the 
advantage to medieal men and tlie pubhe. as wc !I as to 
the nursing pro.^ession, of having a reeognised standard 
of proficicney and eonsequent state registration. There 
.s no fault to be found with our system of state registry. 
t.on of nurses; it works well and maintains a standard 
which acts as a stiniulu. to hospital authorities. 

The nurses' registration act of New Zealand 
u.^es no compulsion, except that of enlightened self- 
interest on the part of the nurses them.selves; but it 
ij rare indeed for a nurse to spend the necessary 
three years in a hospital, going tnrough the routine 
ot training, and not present herself for the state 
J^xarmnation. No important hospital position can 
be obtained by a unless she is registered Tho 
nuniber ot nurses coming up for examination has 
doubled ,n the fo„r years of lQ()6-,,>.„. The i^ro- 
vi^ion for nurses coming fn„n ei.c where to register 

^Ta^^ Colony had the fir.t registration, hut un.Icr a 


A History of Nursing 

is perliaps ratlier k-niunt. Their certificate of train- 
ing from a recognised training school Tor three years, 
with a course of lectures and examination etjuivalcnt 
to that of New Zealand, is accepted, and they art> 
not obliged to pass the examination. As a matter 
of fact, the need of nurses in New Zealand, in s])ite 
of (considering the size of the country) a fair 
number being trained each year, is so great that it 
was inadvisable to shut out desirable additions to the 
number from abroad. It may in the future ^e pos- 
sible to open the door less widely. 

The next step of im])ortance to the nursing pro- 
fession in New Zealand was the passing of an act 
for the registration of midwives. I^iis was accom- 
plished also by Dr. MacGregor and Mrs. Ncill, and 
took place in 1904. The act provided for the 
registration of women with a certain amount of 
experience (gained during a minimum of three years) 
of the work of midwifery, and vouched for by medical 
men as understanding their work and being c^ good 
character. After 1906 women not so registered were 
no longer allowed to undertake confinement cases 
without a doctor, e.xcei)t m cases of emergency. In 
administering this act it was found necessary- in far 
back country places to allow the word emergency 
a wide meaning, as many even of the experienced 
women did not avail themselves of this opportunity 
given them to register, and the work had to be carried 
on. wlnlc fre(|ucntly the nearest doctor would be 
many miles away. ThiviTig passed a midwives' act. 
it was then necessary to provide means of traininj,' 
nurses as midwives. It had been necessary for 
women wishing to become propcrlv fni.nlificd to eo 

In New Continents 207 

to Australia or Grea^ Britain for the necessar^- in- 
struction Jn connection with one or two hospitals 
-the Auckland and the Dunedin, for instance-there 
had been nuiterrity wards, but these were not 
organised training schools. The then Premier (Air 
Seddon). m order to meet this difficulty, determined 
to estabhsh state maternity hospitals, and deputed 
the task of finding suitable buildings and organising 
hospitals in the four chief cities to Airs Neill 
Ihcy were to be for the reception of the wives of 
working men, and a small fee uas to be char-ed 
Pupil nurses were to be taken and fullv trained nurses 
with midwuer>' certificates were appointed Alatrons 
with one qualified assistant. The first four Alatrons 
were AIiss Wyatt, Aliss Holford, Aliss Peiper, and 
Miss Inghs. The hosi)itals all named for St 
Helen and a non-resident medical officer was ap- 
pointed for each one. Dr. Perkins, of \\-eIlingtc;n. 
was the lirst appointee, followed hv Dr A^nes 
Bennett. Dr. Emily Siedebcrg was appointed to 
t^u' Dunedm, Dr. Alice Aloorhouse to the Christ- 
church, and Dr. Tracy Inglis to the Auckland 
' t. Hcicn s. 

The primary idea was that while the houses were 
to be comfortable for the patients, they should not 
t>e equipped in such a ^^•ay that the nurses on going 
'""> <^rdinar>' homes would be at a loss to manage 
^wthout what they had been accustomed to. There- 
I'Tc, ordinary houses were selected and f aed up in 
a Mmple and inexpensive fashion. In such houses 
the work nf the St. Helen's hospitals has been carried 
|m for over five years. Rut it has grown so much. 
'■^e people un wh.Mii ihe ho.spiials were intended 


A History of Nursins^ 

having appreciated llie benefits of being nursed and 
cared for so thoroi ghiy, tlu'.t the time lias come when 
more truly hcspiial-Iike places must be built and 
equipped, and the first to be built on proper hospital 
lines is to be erected in Wellington. During the 
time these houses have been established, the number 
of patients has more than doubled, and the i)U])il 
nurses also have doubled, and in some centres trebled. 

A regular curriculum of instruction and examina- 
tion is laid down. The term of training is twelve 
months for untrained women, but for registered 
nurses it is six months. Each pupil must jjersonally 
deliver twenty women and nurse the same number 
through the puerpcrium. Contrary to the usual 
practice in home maternity hospitals, the nurses are 
trained to be materr ity nurses and mid'vives. In 
the town, as a rule, they prefer to work under the 
doctors, in the country they — being cjualified to 
do so must undertake the full delivery ot cases, 
calling for a doctor only under certain rules laid 
down for their guidance. There are two hosjjilal 
training schools for midwifer>' nurses (bt Ics the 
four state St. Helen's hospitals), one established in 
connection with the mtxlical school in Dunedin, 
and one built in Cisbome by a society cif ladies. 
More and more the trained nurses of the Dominion 
are realising the value of midwifcr}' training, and 
entering for their six months' course, after completing 
their general training. There are usually two or 
three registered nurses in each term at each of llie 

Before the third of the St. Helen's hospitpls — that 

in Aiii'U'l.'inrl — ^vri"-; pqI nK1i\;tii>(1 tlicir frinnflnr \Ir. 



In New Continents 209 

Scddon died when on his way to declare it open 
Of all the great work which this man, so gifted wnh 
the genius ol statesmanshii), accomplished for his 
adopted, perhaps none will have such Iastin<^ 
ericct and do so much for the. coming race of Nevv 
Zealanders as this of founding the four state mater- 
nity hospitals. They are a more enduring monument 
t.. nis memory than any statue or tombstone can he 
Mrs. (.race Neill, his helper in the work, resigned 
her position shortly after this time, and handed on 
the work of organising the fourth. St. Ifclen's Hos 
pitalto her successor. Miss Hester AJaclean was 
appomted toi.ll her place and commenced her duties 
as Assistant Inspector of Hospitals, Deputy Rej,- 

islrar of iNurses and Alidwives, and Officer in Chante 
of the St Helen's hospitals, on November i. i,,,; 
Abss Maclean was trained in the Royal J>rince 
Ahred Hospital, Sydney, and held the certificate of 
ue London Obstetric Society, and the C M 13 
fehe had had experience as Matron of cottage hospi- 
tals and of the Women's Hospital, Melbourne, with 
vanous other posts, which fitted her for the position 
Still another change was to take place in the gov- 
ernment department which held control over the af- 
a,rs of nurses. Dr. AlacGregor. who. with Airs. \dll 
the nurses of New Zealand have to thank for their 
state registration, died suddenly in November, ..;o6 
iJr. \al.ntine was appointed to succeed him and 
iias earned on his work wnh the same regard for the 
general unprovemcnt of all liospital matters. As 
Registrar of Xur<es he has the interests of the nursing 
P^olc^s..,on very much at heart. In „)o.> a r.r^y act 
■■:•- manai:ri;ici 

"'OL. IV.— 14 

'1 iiusj)uais ana ciiantahle aid 


A History of Nursin^^ 

was passed bj- Parliament. TIps act, by plaeing all 
the insliiulicms lor the relief of the siek under one 
general control in each district, has rendered jjossible 
the training of nurses in a wider and more varied 
way than was possible before. This has been referred 
to in the accounts of the larger hospitals. Another 
very important change under this act, and one wliith 
opens out a wide held to trained nurses, is that tlie 
hospital boards are empowered to expend monc}- on 
the nursing of the sick outside the walls of their in- 
stitutions. Thus they n jjay nurses to take charge 
of distant parts of their districts, in this way bringing 
the benefits of the hosi)ital system to those who are 
too far distant to avail themselves in illness of the 
benefits of the hospital itself, and yet under the law- 
must contribute their share in rates. 

Back-block district nursing is the scheme for the 
relief of the sick nearest tlie heart of the insjicctor- 
general of hosi)itals. He, having been for years a 
country practitioner, working far out to the back 
blocks, knew what it was to have no help from a 
competent nurse, to have to ride away, after being 
called a distance of fifty miles to a case, knowing 
tliat his visit liad been of little use owing to there 
being no one able to carry out his instructions. In a 
few years it is hoped there will be no country district 
without its nurse. Nurses of the highest ideals, 
unselfish, sympathetic, endowed with judgment and 
decision, well trainetl and experienced in both general 
and midwitVr\- nursing, are needed for this work. 
(Jrcat responsibility will rest in their hands. Far 
awa\- from a doctor, they will often have to act 
promptly without advice; thev will have to di.qtmose 

In New Continents 


™r;vhci;,';" '° *"* ^■''«''" - doctor n,ust 

. ,, d ,udf,..>K.m a„d c,bs.r.-atio„ J„, a 
JiJ'- Will iiaiu" fiwiti,,- » ,. ' 

'-^n^. uumg to an excellent tele )hono 
-rv,c-u .here arc f.u- p,a.,, .,aUc cm off „„: .^ 

tor buurcuculy u ,s impossible for h,„, „ J 
t'l a jjlace m time. ^ 

A recent case may ser^-e as an exami)le- One of 
our distnet nurses was summoned in the ni ," 
a I'^house-ke^^^^ Hiswifets 

ai)our. _ At once a nurse set off, and after a wild 
ough nde and scramble she arrived three lour^ 

hage, the baby cold and almost lifeless. She set to 
-rk and her efforts were rewarded-both moth r 
ad babe saved. Here it was an in.possibility to " 
. doctor--he was thirty-five nnl.s awa^-. iLk:1 - 
a civ after the arnval of the nurse, the t,de came up 
f the hghthouse was completely isolated. He e 
i> grand work for our nurses to d,> TJ. • 
in tli;« .«.,.• vr ^^^^-^ ^^ ^'^- -Ihe pioneers 

\urw '',''' ^""''^ ^^^^°" ^^he first to start) 
•Nurse Warnock, and Nurse O'Callaghan 

nursing "' '"^^ ^T' '''''' '' ^ ^^'^^^ ^^ district 
nursmg organised by charitable bodies. Nur^e 

Maude, formeriy Matron of the- Christehurch 
-P.tal. started this work in Christchur ' 

^^;'nington It is worked under the St. John's An 
u.^ Association. Mrs. Rhodes, a p^a^^:;:^; 

-nuin of ample means, largely finances this ,,art of 

he uork and was made by His Majesty King nwgc 

Lady of (.race of St. John. In Dunedin also'a 
nur^e connected with the ^ 




John's Ambul; 


'A.ft an 

'ong tlie poor. In Wanganui and 


A History of Nursing 

Palmerston North there are district nurses. There 
has not, liowever, been any very large extension of 
this branch of nursing. There is not the poverty 
among the jjeople, the cities are not so crowded as 
in the Old C(mnlr>-, and the}- are well sujjplicd with 
hospitals; therefore, the need has not been bo 

We must rot omit to mention a branch of nursing 
which has becni established during the last few years 
in several of tlie cities by the Society for the Promo- 
tion of the Health of Women and Children, started 
under the ausi^ices of Lady Plunket, wife of the late 
governor, at the instigation of Dr. Truby King, 
medical superintendent of one of the lar<j;e mental 
hospitals. Dr. King had observed great neglect of 
proper infant feeding, and therefore, great loss of 
infant life, and determined that something must be 
done to educate the women of New Zealand in tliis 
direction. A babies' hospital was established in 
Dunedin, called the Karitane Home for Infants, and 
babies sulTering especially from malnutrition ^^ere 
received there. A carefully worked out form of i)er- 
centage feeding and preparation of humanised milk 
was instituted under the direction of Dr. King, and 
nurses were taken for a special course of post-graduate 
training for three months. Branches of the society 
were formed in diflerent cities and nurses sent for 
instruction, and then to take up "Plunket" nursing; 
nam.ely the visiting and advisitig of mothers on the 
proper care of their infants, teaching the preparation 
of humanised milk when the babies were not breast- 
fed, and general home hygiene. There are ten to 
twelve nurses engaged in this work. A .subsidv is 

In New Continents 


given by the government to the Karitane Home and 
150 per annum to the mamtenance of eacli nurse tip 
to the number ol twelve. 

The history .f„,<; in Xew Zealanu would not 
be complete without the uK-ntion of the efforts made 
u. tram some of the Alaori girls to care f.r the sick 
''1 'hc.r own people. This traming has been under- 
t.iKen by the government, with the aid of certain 
osp^als. Schools for Maori girls have been estab 
hM and aided by the government, where their 
general education is carried on, and as soon as this 
.s completed some few are kept for an extra year and 
c^t as day pupils to the main hospital in the town 
1 his means that they still live at their school, but 
arc given an nisight ino nursing work. If they un 
pear to well the^- are then found vacanaes 
as regular probationers in some hospital and go 
hrougn the ordinary training of a nurse, passing the 
ame examinations and receiving the same certihcate 
a^ the European nurses. So far not many have vet 
completed this training, as it takes four 3-ears ii^ ^H 
and f they go m for an obstetric course also, longer 
he two first nurses to obtain both their gereral" 
and ,nidwifery certificates were Akenehi Hei and 
^^^'"' «_\ hangapirita. about 190S. These nurses were 
tnen given appointments in the Native Health De- 
Partment, and allotted districts in which to work 
ihey were sent to cope with outbreaks of illness 
among the natives, and did splendid work. In an 

;h< meeting house, m wltich .she established an ox- 
.•-■^- iiospitai, and aiso made them dig drains and 


A History of Nursing 

improve the saniuilion of ihc pa. Nurse Heni was 
sent to assist iier, and toj^etiicr they brought fourtmi 
l)atients to recovery and prevented further spread ( )f 
the disease. It is sad to record that later, after 
nursing some members of her own famih' suffering 
from this illness, Nurse llci contractetl it hers( If, 
and succumlic'd after a short illness. Her loss is an 
almost irreparable one to tlie Maoris, as she was a 
woman of line character and with the hi^diest ideals 
of nursing and improving her p(.'Oj)le. The second 
Maori, >.'urse Ileni Whangapirita, is unlikely to 
continue her work. She recently had a se\(,n at- 
tack of typhoid and pneumonia, and ha."> not fully 
recovered. Those Maori girls who are now in train- 
ing have a great example before them in Nurse 
Akenehi I lei, whose work was appreciated ahke by 
Maori and Euroi)ean. 

The nurMiig of infectious diseases has not been 
made a specialty, all the infectious disease hospitals 
being connected with the general hospitals ar^^ 
treated as separate wards to which nurses are .sent 
for a term during their three years' course. The vcrj' 
occasional eases of .small] lox or ])lague are nursed 
in tlie (luarj'iitinc stations l)y i)ri\ate nurses and are 
too few in number to afford an}- opportunit}- for 
training probationers. 

Outside of hos])itals and i>ublie institutions the 
nurses of New Zealand are hugely eniplo>(<] m 
privat'- mir>ing. and in carrying on private hos])itals. 
Private nui -ing is mostly carried on from the ]'riiv 
cipal cities, from which the travel to count ;v 
cases. In some of the lountry towns tlierc arc a 
few private nurses, but this is the exception. 


In New Continents 


Until a few years ago there was no organisation 
an-ng nurses. The first attempt at anything of 
^n. k,nd was started in Welhngton by a small resi- 
; "tud liome being established and managed bv Mrs 
HolKate. who at the same time conducted a i^ivate 
'^-intal for women. An association of private 
nurses was formed, and Mrs. Kendall, formerly a 

K'-l Red Cross for services under fire in India 
^^-; c'lected president. Later, this private nurses' as^ 
^|>cuUion enlarged its aims, and became the Associa- 
t on of Trained \urses. At the same time a bureau 
;^" "^'-^'n ained and a large residential club estab- 
•>->- under the control of a council c-lected bv the 
members, and a Matron, appointed bv the council 
earned on the home. In Dunedin Jn association 

- hospital and i,rivate nurses was started an,] a 
I'ureau also conducted. The example of tl:,. nurses 

- these two cities was followed by those residc^nt 
1 Auckland and Christchurch. Later still the 

^;ur a^oaations agreed to alhliate and bccnme the 
^ew Zealand Trained Nurses' Association. wi,h 
--..ranehes- Wellington. Otago. Canterbury-, and 
Auckland: all adoj.ting ..imilar rules and working for 
'^he same objects. A central couiud for th.e ^^l,ole 
a^-onation .as elected in ,c,(h,, eomposed of four 
'^Hubers from eaeh centre, and Miss MarU-an the 
•\-istant Inspector of Hospitals and Deputy Regis- 
.;'' -t Xurses was elected I'residc-nt, with Mi.s 
i^knell, ofthe Ii<,spi,als' ])epartnu-nt. ilon. Sec^ 
rn h\- ^"'^^•'""-" of these associations haa 

esul cd i„ ,n<ne unity among tl,.. nures. and n„ic|, 
f>^n..fu h;,., been <leriv.d U;mi Ir.tnres tlHiv.Tvd b- 


A History of Nursing 

doctors on various subjects, and by the opportunities 
given of meeting and discussing many subjects of 

In January, 1908, the first pubHcation of a nurses' 
journal for New Zealand was issued. Kui Tiaki, 
edited by Miss Maclean, is a quarterly, and the 
official organ of the four branches of the Trained 
Nurses' Association. It aims at keeping the nurses 
of the Dominion in touch with each other by personal 
news of hosjjital clianges, and with the rest of the 
nursing world by giving news -^^ the great develop- 
ments of nursing in other countries. It also aims at 
ini])roving knouledge of modern medical and surgical 
treatment, l)y publishing lectures and articles by 
medical contributors and by encx>uraging the reports 
from nurses themselves of their experiences and 

Private hos])itals are legislated for in a part of 
"Tlie IIos])itals and Charitable Institutions Act, 
i(;(K)." This is not the first legislation in regard t(i 
tliem, as they were first dealt with in an amendment 
to "The Public Health Act" and again in a se]iarate 
act in 1906. But the wliole spirit (>\ the legishitinn 
is the same the ])r()iection of the ])ublic by inspir- 
tion and control of these places by the government. 
Every house in wliich more than one ])erson is re- 
ceived at a tune for medical and surgical treatment 
atid in which obstetric treatment is intended, must 
have a lieeiiM" to coiuluct a private' hos])ital. A 
lie;i\y penalty is imposed for receiving patients 
without a license. Excei>t under special circiun- 
stances, a license is not granted to any one but a 
registered medical ])raetilioncr, a registered nurse 

In New Continents 


or midwife. Testimonials as to good character are 
al:. . required. The premises to be used are inspected 
atw tlie number of patients one registered nurse can 
b. responsible for are specified. The licens(-d private 
h..spitals are visited periodically by trained nurses 
appointed by the government for the purpose The 
licenses have to be ren-wed annuallv. and can be 
cancelled for certain reasons. .\ nvord of the 
pauents tnvted and the work done ha^ to be kept 
and submitted to the inspectors. The nurse, uv- 
pointed for this work first were Miss I^ukncll and 
-^hss Bagley, both Xew Zealand trained nunses and 
niidu-,ves._ They visit the i)rivate hosfntals and at 
the same time see the registered midwives m the vari- 
^'■>^ distncts, and work specially under the superin- 
tnulence of the Assistant Inspector-General. Miss 

l-nder an Act for the Protccti<.n .f Tnfant Life 
vj'H'h was passed in njoH, there is an opening foi^ 
t!.<' tramed nurse which so far has not been taken 
advantage of ver>- fully. Nurses are rcouircd for 
the inspection of the homes for infants license.,! under 
he. act. and for advising the foster moihcTs on the 
health and rearing of the infants comnutted to their 
charge.^ At ],rescnt all the insjKvtors under the 
infants Act are m,t trained nur-o. b„t as tnue goes 
^" It IS hope.,! tlKit more will ; ,. wHIing to come 
lurward and hcl]. in this imjiortant work. 
Another branch of nursing is that of mental cases 
■>'■ prejudice against this nursing is onlv gradually 
^>'ng out, and as a general rule tlu' w<.men taking 
'^ "P arc not of .so high a class as the general hospital 


Of Infn 

'>; III incniai 


A History of Nursing 

nursing with a three years' course of lectures and 
examination, has been initiated, and a re^nster of 
mental trained nurses, male and female, has been 
established. The mental hosjntals of the Dominion 
— some with 8(X) or 900 beds— arc well ec|uipi)cd, 
fine cstabiisliments, and afford a very fair training 
in the care of the insane. Owing, however, to the 
fact that there is very little illness among the i)atients, 
the teaching of the various nursing mi-thods is very 
difficult, and is more theoretical than jiractical. 
In the future the higher apix)intments in the mental 
hospital service will be held by nurses who have had 
general as well as mental training. A nurse inspector 
visits the mental h()Si)itals {)eriodicaIly, and especiallv 
interviews the women jjatients and examines their 
accommodation. This office is combined with t'l^-it 
of the Assistant Inspector of Hosijitals, and is carried 
out under the I nsptrtor-( General of Mental Hospitals, 
Dr. Hay, formeriy assistant to Dr. MacCiregor and 
on his death placetl in sole charge of the Mental 
Hospital Department. Dr. Hay desires to improve 
the status of the mental nurse and attendant, and 
has instituted a course of lectures and examination on 
the l)a-is of the ni('iiico-])sy(h()loL.Mcal association. 

Tlu' np.rsing of consiunptivcs is carried out chiefly 
in four sanatoria. Two are situated in the North 
Island -one at Cambridge, which is entireh' a jj;o\ ■ in- 
ment establishment, and the other at Otaki, wliieh 
is conneett'd with tlie WiHington Hos]iJl,al. Two 
are in tli.' South Island -at Christehun-h, on tlic 
Cashmere Hills, and at Pahnerston, South in Otago, 
:md cnnnec'cf] with the Christchunh and Dunedin 

In New Continents 


only, and are nursed by a trained staff, in the case 
ot ihe three last by probationers drafted for a short 
I-rnod from the main hospitals. In the near future 
It IS probable that a scheme for fighting this drc id 
<lisease will !k> set on foot, in which the assistance 
01 the framed nurse will be essential in wider fields 
than m the sanatoria. 

Nurses are nearly all eager to get out into the 
world on completing their trainmg-so nmch so that 
It IS difficult to keep a sufiicient number of stafi' 
nurses in the hospitals. Several of the larger ones 
HKike their j)upils sign an agreement to remain a 
l"urth year if recjuired on the staff, after completing 
tl;oir three years' training and becoming registered 
nurses. This si)irit of change and unrest is undoubt- 
edly detrimental to the better training of nurses, the 
Sisters frequently being too junior, or if they tlum- 
sdves have sufficient experience, not being a'ided by 
charge nurses :)f full training. 

The hours for nurses' wcjrk througliout the Do- 
minion are, con-.parcd with other countries, fairl)- easy 
The eight hours' system has been established since 
l^'vS in some of the hospitals, and by the Hospitals 
- 1 C hantable Institutions Act in U)inj, ^^,,s made 
compulsory for all i)upil nurses training in the larger 
h.ispitals. h originated with Dr. k\, ,,v medical 
superintendent of the Wellington Hospital, and or- 
Kani.sed by him on the fines of engineer hours on 
board ship. Whether such hours- during wh„ h 
owing to the smaller number of nurses on duty at a 
I'mc. the work must be rather strenuous- are of 
benefit to tJK' nurses, is a matter !"Mr drmbt. To the 

iaiictus tnc bUcss ami hurr\- 

must HU'vitabh- mean 


A History of Nursing 

less careful and tliorough nursing, and therefore, 
less thorou^'h training of the probationer. Fortun- 
ately the eight hours' system is not extended to tlie 
trained staff nurses and Sisters of the hospitals. Tlie 
united protests of the Trained Nurses' Association 
of New Zealand were called forth at the time this 
law was passed, and with other representations against 
a measure so hami)ering to the work of nursing, 
succeeded in confining the law to the jjupils in train- 
ing. The benefit of organisation was thus illustrated 
in a very jiractical way only a few months after the 
formation of the association. ' 

Tlie difficulty in this country of getting domestic 
helj) renders it (]uitc necessary that nurses who intend 
to ([ualify for the charge of a countr\- hosjiital must 
be able to cook, scrub, and wash as well as nur-e. 
A matron may at any moment be deserted by her 
cook or her laundress and have to take charge of 
stove or wa<h-tub herself. .Sonirtimes, too, tlie 
nursing work in the very distant small hospitals is 
not suthcicnt to justify a staff of even one additional 
nursc", antl the matron must depend chiefly on tlie 
hel]) of a wardsman whose special duty is the care of 
the grounds. In s]jite of all, howevcT, we find 
those who stick to their work under all disadvant- 
ages and love their little hospitals. They work Iiard 
wiien necessity arises, and are on duty day and night 
when any bad case is in, intleed welcoming a bad case 
with delight. A typical hospital of this kind i; the 

• As overwork in hospilats is a grave proLkiii in many countries, 
it seems a pity that this fortunate land should find its nurses criti- 
cal of the cij^hl-hour hospital day. It probably only needs some 
moilifieatior! a-i to change ■;•£ -hifts.^Eo. 

In New Continents 


Taumaranui, which is situated on the rrain h-ne 
betu-een Wellington and Auckland, and in a si)arselv 
Mtikd distnct. The Matron there has no trained 
assistant, and the probationer nurses she can s, cure 
remain only long enough to be of some use ^^■hen 
It they arc any good, they go on to a training school' 
There is also a general servant and a man on the sfifF 
rhe hospital is administered by the government. 
Inore are six beds and now and again eight or nine 
patients, at other times ..nly one. The i,atients are 
all acute, sometimes bad accidents from the saw- 
mills, needing careful and continuous nursing and 
in such case the matron is allowed extra assistance 
irom Auckland. A Christchurch graduate, Aliss 
<'!ll. who went there as Matron, wrote shortly 
alter arrival. 

\v c were now ready to take patients, but none were 
forthcoming. As t he mills in the district were not work- 
>:■:-, and no one in the township was sick, our attendanre 
was not required, therefore nurse and I proceeded to make 
a track for ourselves down the hill to the river. We went 
forth armed with slasher and spade, and cut and du.^ a 
v.-> path. We then s.t up numerous sticks with 
ra-s tied to them, so tnat we shinild e;^;ilv find tlie truck 

•n the scrub A new difficulty had arisen; who was 

o look after the acetylene gas plant, and the oil engine 
by means uf which the water was pumped to the house? 
Urtamly the man about the pla.v. an<l he- <Vn] so when I 
ha>. one with sufficient int(iHgenee to understand it 
But supposing the man should take it into his head (as 
they sometimes do) to go off at a moment's notice who 

then should 

\V( >rt 


. but 

the cng 

:ine iind j^as i^l.'int? Xoth 


tiie .M.iLron must learn h.nv. Tliis I jmunptly 


A History of Nursing 

did, and I am sure yim would have lauj^'hcd at my get-up, 
when, ihe water K^Uin^' low in the tank>, 1 had to i;o into 
the enj^'ine-house and clean and start the engine This 
was no hardship as I am fond of cnjj;ines. But it was 
very dirty work, and later on when myself and a proba- 
tioner had nine jiatients to nurse, three of whom were 
typhoids, I really could not find time to do it . . . but I 
was sorry to give up that engine. 

Steps are now beinj^ taken to form a Nursing Re- 
serve under the new Defence Scheme for N ew Zealand 
as organised by Major-Gereral Godley, an Imperial 
officer, on lines recommended by Lord Kitchener, 
after his visit to the Dominion, in 1910. The nursing 
reserve will be under civil control and organised by 
the Inspector-General of Hospitals. There was a 
previous attempt to form a reserve, and a Matron- 
in-Cliief, Airs. Janet GilHes, formerly Nursing Sister 
Speed during the South African War, was appointed 
to the position ; but ihe reserve was not formed and 
she has now retired. A new Alatron-in-Chief is to 
be chosen immediately and the a])pointments of 
Matrons, Sisters, and nurses will follow. 

Africa.— Africa is known as the " Dark Continent," 
but darkness is giving place to dawn, and dawn 
with tropical rapidity to broad daylight. A powerful 
factor in this development is the trained nurse, who, 
following the flag, has found her way to the heart of 
the continent, so that m Uganda, on the shores of the 
Victoria Xyanza, there is now a hospital having a 
three years' certificated nurse as Matron, and on the 
i-land of Likoma, on Lake Kyassa, there is a w("- 
npncMnti'd hospital nursed by certificated British 

■ -" n .t. ,'>J 

■ ■ 


% ■ i 



*■ J«il^ 




KnK'li-ii llM~.|jii,il, Z.iti/; Mi-^ Hn;iy .iml Mi H;v\\vr;on in tlif 


In New Continents 


nurses. The same may be said of Zomba. head- 
quarters of the adn.mstration of Bnt.h Central 
* V I ricn. 

On the northern seaboard British nurses are doin<^ 
xa.lh.nt work nj hospitals at Port Said, Alexandri^^ 
. nd Al,,ers, whde at Cairo there is a lar.^e hospital 

aff, .n vvh:ch native nurses are trained. This is 
the only reeognised training school in I•:g^■pt for 
nurses or midwives who are registered hv th;;ove n 
m-t^ On the west coast n.any liv.; ha.^ :^ 
aved by the good offices of members of our profession 
n the hospuals at Sierra Leone and Ligos, and 

trained nurses have also gone inland to nur'e mem- 

b.s.^tl.U est Frontier F^ 

On the east coast there is at Mombasa a govern- 
ment hospital founded originallv by the Imperial 
Bntish East Afrk-an Con.pany, which was nurlld 
irst hy religious Sisters, now by nurses sent out by 
the Colonial Nursing Association. At Tanga is 
another under the p-.ta r^f n ■, ^ 

uhi-lo ft ■ , ., Oerman deaconesses. 

nh le the island ot Zanzibar, the metropolis of th^ 
east coast, has English. French, and nativ^ hospital! 
1 he .ormer is interesting, inasmuch as in it som. pro- 
K-ress has been made in giving systematic instruction 
to native men and women in nursing. The ho^Dital 

'maintained by the Universities' AHssiont:^r:; 
-\tnca. and has a nursing staff of a Matron and five 
or SIX Bntish certificated nurses, who take consider- 
; We pains to train the natives who work under them 

r cei" ' 1 ''" ""'^' " ''''''' '' ''^'-^ ^^f"--"" thus 
nceues instruction m habits of order, method, and 


A History of Nursing 

discipline, and in an api)reciation of the value of time, 
which are foreign to him naturally. So far the men 
have, on th(> whole, made belter nurses than the 
women, iiarth- because tlie latter marr>^ so early that 
few oi tlietii st:iy in ilie hosjntal long enough to pass 
througii a full iraniing; partly because in Zanzibar, 
as in other ( )rieiual couiuries, ilic men are in advance 
ot I lie wonuTi in educational development; ])artly 
again because the male wards are more used and so 
afford a better traitiing gnnmd than the female wards, 
and it would outrage national feelings to jJace an 
unmarritMl woman in charge of men's wards. Never- 
theless some of the girls have proved themselves aj it 
and trustworthy pii])ils, and, given ecjual advantages, 
would no doubt bccf>me as jjroficient a '':c men. 
Thiy have luany of the characteristics essential in a 
good ;uirsc, bring gentle, kind, symjKithetic, dextrou:, 
with their hands and (juiet in tlieir movement-. 
I^iey are also, as a ruk-, devoted to children. On 
the other hand they do m>t liki- performing jiarts of 
the work which tiay consitler nu nial, and they have 
not nuicl! sense of responsibility; neither have they 
nujch Stan ina. 

Two rea.sons iiiay be assigned for the dislike vi 
t!ie natives to menial work: they have too recently 
cmerg(-l from slavery and many have had i)ersoiiai 
e.\i)erience of tlu- horrors of the slave caravan. Tluy 
have a pi-ofouiKl di ,like of doing slave work, and a 
conmion objection is, "I am not a .slave." Then, 
too, as the riglit hand takes the jilace of a s])<H)n 
among llie Swalnlis they are ver\' ]> .ns t,i 
its cleanliness. So far a- !)ractical wor!; goes, both 
native me .uul women in Zanzibar have learned 

In New Continents 


enough to make them very useful. For i,isiance 
Ihcy cani)olish instruments and prepare lor an op.ra- 
^■'-n in a way wluch would be creditable in an up-to- 
date Lon.ion liospital. iheoretieal work has 
^o tar, la-od behind the praetieal. and there are at 
present no nursin<^ text-books in tlie Swahili lauK^ua^e 
Ihe mfluenee of the training given in this lu.pital 
IS tar-reaehmg, as many of those who r'Hvn c- h re 
'umto their tribes up-countr>-, and thus earrv 
nursmg knowledge to villages where no I-u;opean 
I' stationed. 

No aeeount of the hospital of the UnivcT.sities' 
Mission m Zanzibar would be complete without 
n ention of th gracious and cultured woman at 
^vhose instance .t was built. The mission had had 
>..any devoted nurses, but their work was done undcT 
nifhcuh and unsuitable conditions. It was owinj: 
'0 the initiative, and the strong rc.pnsentations ma<le 
•" 1890 by Miss Emily Campbell, a nurse possessed 
<•! rare charm and professi..naI skill of a high order 
; otnbined with absolute devotion to the sick.- a saint 
in the making. -that the mission owes its hospual 
in whu-h her, notably Mis. U. Brewcrt-n' 
for many years Matron, Miss S. A. Whitbread, now 
K' MissM. Brown, Miss(\ L 
^'"-1 many others have rendered the most devo-e'd 
•^yrvice to pati. s of all colours and ereeds. AHss 
t ••nipbell henc. did not hve long en.„u.h t.. see the 
'-"'Pletion and opening of the ho,„i;.l. ,,nd her 
•l.vith. aftei two years' work m the nn.-ion. wa. an 
■"'l<''l urgent proof of its nee.i. for she died '"of sheer 
'■•vrnork. m,r ,ng single-hande.i a ju.i.sonous case 
•- .1 lioiise eniineniK- uns!!!!e!l d.r •,,,.?, 



1 I i«;,M' 


A History of Nursing 

. . . We could iiot but be influenced, every one of 
us" said the Reverend Spencer Vv'eigall at a meet- 
ing of nurses in London, "by having a character of 
such extraordinarv beautv amontr us. 

Another heroic pioneer worker for the sick in 
Zanzibar was Mme. Chevabler, who gave devoted 
service in connection with the French mission. 
Mounted on her beautiful white donkey, she was a 
well-known and notable personality on the island, 
where she Hved for over a quarter century without 
returning to France, making the lepers her special 
care. Mention must also be made of a midwife, 
who is at work in the town of Zanzibar, under the 
auspices of the Lady DufTerin Fund. 

We nuist turn to South Africa, however, to find 
nursing organisation in an advanced condition. 
Nurses there were the first to secure legal status 
and registration under state 1 ws. This was con- 
ferred upon them by a section of the Meoleal and 
Pharnuicy Act of 1891. The administration of the 
act is carried on by the Cape Medical Council. 

It was largt'ly to Sister Henrietta of Kimberlcy, 
an I':;nglish nurse and daughter of a clerg>-man, tiie 
Rev. Henry Stockdale, that nurses in South Africa 
owe the honoiu-able distinction of being the first to 
be registered by Act of Parliament in any country. 
Sister Henrietta attended the Loiulon of 
Women, in l,S()(), .ukI tlx re told the mir.^cs, assembled 
in tlieir lir^t iiilenialional meeting, how, when the 
new iiKMhcal bill was betme the Caiic ]iarliament. 
the trained nurses of the country, a httle band of 
some sixty-six women then, now (juite an aitnw 
petitioned almost unanimou.sly for a place i»n the 

In New Continents 


register and for state control of education. With 
much care and forethouglit clauses were drav/n up 
providing for the registration of foreign trained nurses 
and state examination and registration of the colo- 
mal-trained. A section also deals witli midwives 
I he nurses gained their wish, and after this length 
of time, the act has on the whole worked well Sister 
Henrietta continued her life of active usefulness for 
many years; took a prominent part during the siege 
ot Kiniberley and afterwards, in organising the care 
ot tlie wounded and sick, and died, full of good deeds 
and honours in 1910. 

This first registration act gave a year of grace 
during which time all nurses h.^lding hospital cer- 
tificates could register, One year', training was at 
first accepted. In 1892 the minimum was set at two 
years, and finally, in 1899, three vears in a hospital 
ot not less than forty beds was fixed as the minimum, 
and the medical council set a syllabus of subjects for 
examination and fixed the lines of training at much 
the same as in the best English hospitals. Medical 
>nen delivered lectures preparatory to examination 
and conducted written and oral examinations in the 
different centres. 

South African nurses have f,Mmd. however, that 
'luTc IS a disadvantage i;i liavi-ig no nurse sitting 
ni)on the council, and liberal physieians h.-ve learned 
the same thing. In 1904. a report on the ac-t and ,ls 
workings wa.^ s.^nt to the International Council of 
.\urses by i)r. Moffat, then resid(-nt. surgeon at t'^e 
Somerset Hospital in C\ape To.vr, in wliich he said: 

Ttic Ifcit:!-,) ;,>,-, „nr.,. 

;;cs is ^r.Hiuiiiiy imi)rovinp 


A History of Nursing 

the education of nurses and raising the standard of pro- 
fessional knowledge. 

I venture to suggest, even though I may tremble at 
the thought of what our Council would say to such a 
thing, that some at any rate of the members of the 
Council should be trained nurses, who could discuss and 
vote on nursing questions. Probably in time there will 
be a Nursing Council; some of these should be trained 
nurses. At present the members of our Council are all 

In the same way, I think the examination should be 
conducted in jiart by trained nurses. 

The great gain wliieh would follow frr)m the two latter 
additions does not need to be poinicil out. 

In 1899 registration of trained nurses was enforced 
by act f)f Parliament in Natal, and in 1906, in ttie 
Transvaal under the Transvaal Medical Council. 

Some of ti.c South African hospitals are fine build- 
ings, and in a number there are training schools of 
excellent standing. Certificates arc no longer granted 
by individual schools, as the medical council now 
issues its own by the authority taken from the 
hosjMtal authorities and vested in them. With the 
devclcj^ment of the countr}' and the ad^-ance of 
nursing, we sliall hoiu- to see nurses ])laccd on the 
examining board, but this will perhap.s not come 
until women are enfranchised. 



India. Among Miss Nightingale's writings some 
of the most remarkable evidenee of her genius is to be 
tound in articles published in her later ^•ears on the 
problems of life in India, as affected bv government. ' 
In an earlier volume^ we have dted her i)lea for vil- 
lage sanitation in that country, but had not then seen 
those writings in which she analvses the whole social 
-rder of India, tests every detail of l.-,nd ownership, 
taxation, social, and economic organisation in the 
clear tire of her int(Tpretative intelligence, exposes 
every weak, wrong, or oi)prcssive point with her 
vivul, flashing gift of demonstration, and constrticts 
iH'm by item, with a rare statesm.inshij) and a prac- 
tical force all h. r own. the programme bv whi.h 
alone the real .sources of famine, pestilence, and 
m,<cry could be readied. ..f an intdlectnal 
outlook and human insight so broad and deej) should 

' "The People of Indi.i," Ntnrta-nth Century, Aupust. iSyS- • The 
Dmnb shall Sp. ak :..„! ,!,. \\,,i .hall I „r th., Ryot, the Zenmniar 
amUhcGovcrnnu.nt.' journal of th,- l-ast India As^acintion I,.- ' ,n 
'1?'."u '"/.''"'*■'" •^tcwardsh,,,,- X.nrlcrnth Cn.turv, .Anpt'.st, ,hn/ 
rUaith for Rural Ind.a." in Ind.a, (a magazine").' 
London, iHo6. 

' •! //f^.'-'rv .-jf .V;,-r-r5;.: '.'..1 I'. 


230 A History of Nursing 

never be allowed to fade in obscurity. They should 
l^e in every public library. Plad they been written 
by some cabinet minister they would stand, richly 
bound, on the shelves of every man in public hfe, 
even if their recommendations were not followed or 
even read. Her mastery of enormous official detail 
and technical, statistical facts as shown in these 
pai)ers is amazing', and suggests that t!ie greater part 
of her later 3-ears must have been given to an intensive 
and laborious study of Indian affairs. This was the 
hard work which filled her time and left her in her 
invalid's room no leisure, for she continually re- 
ceived ma.^ses of official documents, suc-h as ivw other 
persons ever saw, and \\hich were sent for her con- 
fidential analysis and commentary. We do not know 
exactly what results followed these labours. Here 
she launched far forth from nursing subjects to deal 
with Imperial policies, yet every flash of her mind 
showed that her basic thought was of health the 
health of a nation and the happiness to a race that 
could result from it. 

The eariicst efforts to tran.splant English nursing 
into India came through the mi.s.^ions. To describe 
their gradual advance is beyond our province and 
our powers. The nur^.s who shared in it, pi.mcers 
in the fullest sense, were sent ready trained from the 
mother countries, and we must be content to begin 
this record with tlie first work in training native 

Whether .simple human siTvico tn of tiers' needs 
should I)c made the vehicle for coiitrov.rsial pro- 
paganda is a finest ion whi( h must be jinswcred by 



',•-." 1 

n ntiW fai ll!C 


23 i 

work of meclical relief may be developed when allicl 

'ur ,. also debatable, ^'et tbe mission ;pint 
^ ; ; ^'luays led the way to service in th. hardest mo" 
Ja: serous p aees long before any one else was re "d^ 

- .^ and dunn, two thousand years we have ^n 
n^^daal missions breakir,, the ground for a new 

!n papers eomplained that the most powerful 

u;^qjonu..d by the Christians to lay holi oi^^ 
-^ r^ 01 the Hmdu women was the Zenana hospital 
hey perhaps telt that their people were bemg il em 
t::^' saered tradition. On the other hand 1^ 
and eare expressed in mission work were always 

- -hed espcvKdIy on those downtrodden and inferior 
-n,s whose sex .r easte gave then., utuler the old 
•spensations. httle to hope :or „, h.aven or'.^^ 

"Here, so why should they remain bound bv he 
-vent,ons of anaent histoneal rel„,ons 1 : ^ 
'•-everbeautnul in ideals, had beeome in pra, ce 
f.n of negations for workers and for women ^ The 
--:onanes entered. inspire<l by a purpose ever 
''>!'. pure, and strong, and eonseerated all 
-vers o ,he task of awakening soul and spin 
'. tned,.al woman and the nurse were irresistible 
;; '"' "^^.'".^•^^••^ "-•^■^•'^nat to whom thev m„.stered 
'1 -suspiaon and aloofness melted awav before 
^'■:- skilled, tender handling of poor d.eased bodies 
,„ ''''' ^''"'^•••' ^"'- '•"■"King medieal eare and 

-'-. on a national seale to the people of Ind!!: 
■',' "---'J'^a far-reaching and auton,,n,ous 

';"\''.v winch centres of teaclmu^ .nnrl ,,...;,..•.., 
^" "' '- 'm,i.,plu.d. according to local n^eds'^u^ 


A History of Nursing 

the work of the Countess of Dufiferin, during her 
stay in India as "first lady in the land." fler plan, 
built upon large and comprehensive lines, was de- 
veloped with wisdom and foresight, and shines 
brightly in that tale of ujjbuilding and conservation 
<\-hich goes to balance the long dull histories of de- 
structive forces. How it came into being is best 
told in her own words': 

When I wa.s Icavinj,' England, Her Majesty the Quccn- 
Emprcss drew my attention to the subject [of suj)i)lyin.i,' 
medical aiilj and said that ,he thought it was one in 
which I might take a practical interest. From that time 
I took pains to learn all that I could of the medical (juc. - 
tion in India as regards women, and I found that, tli"uj.;h 
certain :rfat efforts were being made in a few pla; cs to 
provide female attendance in hospitals, training schools, 
and disiicnsaries for women, and although missionary 
ctTort had done much, and had indeed for ycai's been 
sending: out pioneers into the field, yet taking India as 
a whole, its women were undoubtedly without that med- 
ical aid which their Euroi)ean sisters are accustorneil to 
con.-:ider as absolutely necessary. I found that c\-cn in 
Ci'scs where nature, if left to herself, would be the best 
doctor, the ignorant practice of the so-called midwife 
led to infmite mischief, v.hich mij^'ht often be character- 
ised as abomina!)ly cruel. It seemed to me, then, that 
if only the f)cople of India could be made to realise that 
their women liave to bear more than their necessary 
share of human sufTerini,', and that it rests with the men 
of this country and with the women of other nationalities 

•See The National Associai >n for Supplying Female Medical 
Aid to the Women of Inciia. H. ' 'ic CouiUc^s i.f DulTcrin, roprint."! 
from the April Asiatic Quarterly Rniinv. Calcitta, Tliarker Spink 
& Co., iSoo. 


'^ 233 

to relieve them of that unnecessary burden, then surelv 
I h. men u-ould put their shoulders to the wlieel and would 
(ietermnie that wives, mothers, sisters, and daughters de- 
pendent upon them should, in times of sickness and pa-^n 
have every relief that human skill and tender nursin.: 
-uld auord then.; and we, ^vomen of other nationalities 
. . we surely too should feel a de<.p SN-mpathv with 
onv less fortunate sisters and should, each one of us en- 
deavour to aid in tl,e work of nuti^atin^^ their suflerinrs 
1 thought that ,f an association eould be formed which 
-^^v-uld set before itself this one .single object, to brm,: 
m.heal knowIe<l,e and medical relief to the women of 
ndua, and which should carefully avoid compronnsin. 
th.' s.mphcuy of its aim b^- keeping clear of all eontro- 
vcrsul subjects and by working in a stricth- unsectanan 
spmt then it might become national, and ought to a.m- 
niand the support and sympathy of e^•crv■one in th- 
country who has women dependent upon hhn. 

With this idea, Lady DufTcrin took her ini'ial 
steps and her plan was warmlv received. A pro- 
spectus was drawn up and published in various lan- 
guages all over India. The association was named 
he Aational Association for Sup)i;lving Medical Aid 
t" the \\omen of India; and as the monev for -. 
nvis cc.llected, it was credited to the "(Vumtcss of 
>>'ifenn s Fund." The press and public were readv 
I'Tit Few objections were heard. One. however 
i';'l torward by conservatives was. that the women 
•■' 'he country did see medical men professionally. 
t" which bady DufTerin answered that this was onK^ 
>n the^last extremity, when the medical man admitted 
t" a Zenana entered with his head in a ba- o^ re- 
"■"■'"'"" '•''*'■ P^'uaJi, ieeiing ins jjatient s p.use. 


A History of Nursing 

but unable to examine her. (A medical missionary 
in India knew of a string being tied around the 
patient's wnst in a critical case and the doctor, in 
another room, given the string at its other end tcj 
feel the })ulse!) Said Lady Dufferin in discussing 
the objections: 

Others simply state that the women do not want 
doctors at all, and that, therefore, any scheme for ^'ivin^ 
them medical relief is unnecessary and qinxf>iiC. To 
refute an arj^niment properly one should underst. nd it, 
and I confess I do not understand this one. It seems to 
me simply to point to the total aboliti' n of doctors and 
to the extinction of medical science altogetht r. . . . Hut 
it is true that in India, as elsewhere, men lave all that 
they require in the way of medical avlvirc, while the 
women here have not, and the oljjcct of this scheme is 
to remedy an occasional injustice. If women 60 not 
want doctors, then men can do without them. . . . 

The criticism that the as.-ociation was "ofncial" was 
also made, and to this Lady Dufiferin, after jjointing 
out tliat it received no government aid, said: 

We are honestly desirous that it should become un- 
olTicial and truly national, and we arc makin.iL: every effort 
to pjare it upon a really j^opular ])asis. We are merely 
birds of ])assa^e licre, and if the work is to ^o on and 
prosper it must be gradually taken out of our hands and 
be undertaken l)y those who li\-e in the coun-^y and for 
the Ijcnefit of whose women it has been begr.i. 

The affairs of the association were managed by a 
central committee, of whicli the Countess, during 

lv.^V^X 1 <j • 

A * I f^ltlK- I L<^CJ y> < I \, 



connected with the central body, and by this ariau- 
latcd form continuous growth was made possible, 
to include and Cf )ver the whole country. Each branch 
a.^sociation was, for all financial and executive pur- 
I ><cs, entirely independent, but was expected to 
aiihere to the piincip.les of Uu; national association, 
and was a.sked to contribute a small jxTcentage of 
its receipts to the central fund. Pi blic meetings 
ere held to explain the purpose of the fund and to 
arouse luLerest. Existing institutions and organisa- 
;ons having the same medical work in view were 
encouraged to affiliate with the ..ssociation, their full 
independence remaining unimj^aired. This arrange- 
niruL was meant especially to affect mission societies. 
Such affiliated groups, it. was explained, might obtain 
^'rants from the associc' ion for sjiecial purposes, 
while all would benefit by having a ..ommon centre 
of reference and information. The objects for which 
tlie association was esiablished were set forth in its 
]niblications as being: 

I.--^rcdicaI tuition, including the teaching and train- 
in.' ill India of women as doctors, hospital assistants, 
nurses, and midwives. 

I [. — Medical relief, including the establishing under 
fcniale . iiperintendence of disj)cnsaries and cottage ho.s- 
I'lials for the treatment oi women and children; the 
opening of female wards under female superintendents in 
exi.sting hospitals .and dispensaries; the i)rovi3ion of 
female medical officer:^ .nd attendants for existin- female 
■'■.mis; and tlie founding of hospitals for women where 
s;H\iaI funds or endowments are forthcoming. 

III. — The siniplyof trained female nurses and midwives 
lor women and children in hospitals and jirivate hou;scs. 


A History of Nursintr 

The national association, as above outlined, ivas 
organised in August, 1885. "Its one aim and aspira- 
tion," wrote its foundress, "is to bring to the women 
14" India better health, freedom from imnecessary 
I)ain, and all the comforts and alleviations which 
science has discovered and which the ministering 
hand of doctor or nurse can supjjly. ..." 

In an article written upon the work, Lady DufTerin 
recounted some of the difficulties met : 

A last difficulty is that we start our medical work with 
scarcely any supply of doctors, midwi\-cs, or nurses to 
hand. There is not one sin-lc native female doctor 
ready, though about forty arc now Ijcing trained. [The 
number of such students is rai)idly increasing.] A few East 
Indian ladies have been educated at Madras and have 
all the necessary qualifications [to some of these, posts 
were ofTercd], but the country itself is, undoubtedly, un- 
able to supply even the {)resent demand for well-educa- 
ted doctors, well-trained nurses, and efficient midwivos. 

In regard to the missions, she thus explained the 
principles of the association : 

The national association cannot employ missionaries, 
nor can it provide hospital accommodation in which it 
is intended to combine medical treatment with religious 
teaching. It may, in certain eases, be glail to avail itself 
of medical missions as training agencies, and may oc- 
casionally attach an assistant to a mission dispensary. 
[For further training.] But in such cases it would have 
to be clearly understood that the assistant's duty would 
be strictly confined to medical work. No offiicers in the 
employ of the national association can be allowed to 


iiie uauoiiai assoeia- 




tion cannot undertake to provide funds for the travelling 
expenses or establishment of medical missionaries. 

While defining the purely humanitarian character 
01 the work in thus standing aside from doctrinal 
iraching, the intention of its foundress was to unite 
;:I1 bodies in the pliilanthropic work common to all, 
and not to intervene where the mission already oc- 
ci;]ned the ground, except in towns so large that there 
was room for a second medical establishment, or 
wlien the demand came from the people of a locality. 
Slie wrote: 

The function of the central committee is to act a. a 
I'.Tik between all branches, to collect mformation, give 
advice, and assign grants-in-aid. It is in direct com- 
munication with those parts of the country where no 
brnnches have been formed, and with those Indian princes 
WHO interest themselves in the movement and who are 
..ndcavouring to promote its objects within their own 
doniimons. Its duty is to study the information re- 
ceived, so that it may understand the wants of different 
localities; to see in what direction it can best help each- 
an, I to administer the funds at its disposal for the benefit 
of the most useful institutions and the most nrcdv 

The central committee has also the responsibilitv of 
directing the poHcy of the association . . . to consolidate 
and to improve the position of the society. ' 

Tliough in no way an arm of the government, it 
being understood that the employees of the associa- 

■ From /I Record of Three Years' Work of the National Assoa^. 
_'< '" for Medical Relief to the Women of India. Aurust. ,f!Rc >.. ,,c,ci? 
^J tue Aiarchioncss ot Duflerin and Ava. Hatchard, London, 1889^ 


A History of Nursing 

tion were not employees of the government, a certain 
« ifficial recognition was granted to the medical women 
and others emi)!()yed by the association, and there 
was also a certain amount of direct co-operation by 
1I10 Surgeon-Cieneral and the chief medi'.'al officers 
()! ihe i)r >vinces. Tlie whole amount subscribed 
to the fund, even in the first few years, was a i)rincely 
sum. From the subscriptions received, a certain 
amount was set aside as an endowment fund, and 
at the end of three years' wcrk enough had also been 
set aside from income to endow six medical, twelve 
nursing, and twn hos])ital assistant scholarships. 
Besides this, annual grants were made to medical 
staffs and nuising exi)enses in a number of cities, 
as well as a greai deal of current outlay of varied 

The impetus and definite help given by the fund 
was general and varied, and to deal fully with its 
extent would far overpass our bounds. In medical 
relief iii lHH(). twelve hospitals for women and fifteen 
disjx'nsaries, iiiost of wliiclt were officered by women, 
were more or less closely connected with the associa- 
tion. .Many were tlie new entf'q:)rises, private and 
])r< »vin;'i;Ll, that res])onded to the stimulus thus given, 
and iii.iny were the localities that undertook the 
maintenance of some brands of rc-ief under tlie fund. 
Hver watchful of tlie best development of her plan, 
Ladv Dullerin wr'ite in I^ib8: 

T shonlil like in this place to remind those who have 
undertaken to l)enefit their slate or their district by e.-- 
tahlishini,' one of these institutions, that they must thitik 
of lli^' fiiUire as well aj uf ilie presint, ami that they nn; U 








year by year, send to one of the medical schools girls 
from their own neighbourhood, to stud}- medicine, to 
become compounders, uurscs, and dhais, so tliat the 
li<)si)itals llicy have started may never have to be closed 
for want of feinalc officers to direct them. 

She wrote further: 

I believe the teaching of midwifery to be the most im- 
portant and the most urgent work we have to do, for 
this science is grievously misunderstood jjy the ordinary 
dhais of the country. Few people know the dreadful 
• Tucltics perpetrated by these women imder the guise 
(if pn fessional aid, while those who sulTer at their hands 
;.re loo ignorant of any better treatment to resent their 
malpractices. . . . Part of the treatment, before the birth 
of the child (as shown in oflicial reports) consists in 
kneading the i)atient with the foot and stamjnng upon 
her hip joints, while in extreme cases a pole is ])laci'd 
acro-ss her, the attendants resting thjir whole weight on 
t ither end. 

The details are often too painful to repeat, but, 
as leading diaractcristics, conunor to most parts of 


tliere is the unhealthy room, remarkable for the unsani- 
tary nature of its arnuigemcnts; there are the charcoal 
lire, the abr'.olute l.iek of ventilation, and tlie crowd of 
S|)ect;Uors; there is the extreme and aecunudating dirt, 
and added to all this the further d.anger attendmg the 
'■'inistrations of the ignorant or 1 he rarekss or the vicious 
'•hai. Nor can wi , in the ease of Indian women, comfort 
ourselves, as we are apt to 10, with the idea ihat they 
lead a more natural life tli.m I'Luropeans and, tlKTcfore, 
sulTer little at childbirth. The very contrary is the 


A History of Nursing 

The I'vcs led by all but the very poor are most unnatural, 
and as they marry unnaturally youn<r, they suiier more 
at the time, and arc much more liable than ol r women 
would be to injuries causing lifelong suflering. ' 

The work of teaching niidwives and nursi-s, most 
arduous and difficult as it was, went on, at f>rst slowly 
— then with gratifying steadiness; the Dulit -in ilos- 
pital at Nagpur was the first one for .01.. on and 
children in the central provinces. T is impossible 
for us to mention all the branches anc. work ui.der- 
taken, but the map of India in the reix)n. of the 
association, showing all the centres of work under 
the fund in red, i.-i a revelation, while from ^-ear to 
year the beneficent results of its activi.ics are more 
widely extended. The yearly reports -^ should be 
studied for the most recent information. 

In closing her report. Lady Dufferin said: 

It is a sense of obli,L;ation . . . that I wi ;h to instil into 
the minds of men l'iroui;hout ;his country. I want 
them to look upon the provision of medical aid for their 
mothers, wives, and daughters, as a positive duty, and to 
give not <>nly money, l)ut time and talents and jiersonal 
laI)Oui to procure it for them. ... If relief is to !•(< 
brought not to tens, but to hundreds of thousands of 
Indian homes, as it should be, then it is not one society, 
or a certain number of single individuals, who can ac- 
complish such a task. It is the determined attitude orf 
th<' moil of this country which must do it. It lies with 
them to give tlie women relief in sufTering. . . . 

' I'ri,rn .1 K,\ :rd of flirrr )',-iirs' U',iri: of ihc K,itional Asuxul- 
lion for Medit itl Relit f to the Women of India, A ugust, iSSs to l8SS, 
by the Marthioncs.. of Dufferin and Ava. I I, Londim, 18S9. 

M'rinieil at the Biiinliay Giizcltc Electric Printing Wurks. 



The first regular training school in India for the 
systematic instruction of native i)upil,s in nudical 
and -argical nursing, as well as midvviier\-, was ns- 
lublishcd in 18H6 by the liombay brandi (,f the 
Countess of Di .ferin's Fund m connection with the 
Car . Ilosi)iial m Bombay. It is a civil institution 
under government management and is solely for 
v«omen and children of all castes an ■ all denomina- 
tions. Two English phys-.-ians and a staff of Eng- 
lish nurses ojK'ned the work of the hospital, but the 
training school dates from the appointment', little 
later in the same year, 1886, of Miss Edith AtkinMm, 
a; lady superintendent. Trained at tlie V<,rk 
Road Hospital in England, sjie had gone to India 
m T884 and had served in Si. George's and otlirr 
c-nt.res. An exceptionally able and sym})athetic 
woman, she gave a wh<.k-Iirarted devotion to her 
w.-rk, and died in 1905 after nineteen years si)ent in 
the training school. Two au.xiliar>' institutions are 
now allied to tlie Cnma, both the gifts of wealthy 
Indian gentlemen and named after them- one an 
obstetrical hospital, the Allbless, and the (^ther a d...- 
lynsarj- for women and ehi!dren, the lalfer Suh ini.-m. 
Ihese are entir-ly in charge of women j^hysieians. 

The nurses' train- ig, at first one year, was ex- 
tc'nded to one ;-nd a half, and in i<>()5 bn-ught up to 
til.' three-year sfmdard. T' nigh the stalT nurn^s 
and. ho.spitals are supported by the government, the 
tniining .school is still kept up by the DutTerin Fund. 
It was at first impossible to get nati\ - women to 
Hve their homes for more than a year, but they 
I'Mmed (o do so readily, and, between i.SS; .-md r(jio, 
^-^" pur^il had been trained and seven had had six 

Vol. IV. — 16 


A IHstory of Nursing 

months miJwifery as wfll. In the year last men- 
tioncd, Miss S. Grace Tindall, the lady sui)crinten- 
dent in charge, wrote: 

Our pupils go into all parts of India and often return 
to their old school in positions of trust. I have former 
pui)ils as eharj^e nurses in the civil iiospitals of Maymyo, 
Karachi, and Moulmein, and have placed native nurses 
in charj,'e of female wards in Amritsar and elsewhere. I 
am asked to fill more vacancies than I can possibly 
supply, showing that our nurses are appreciated. 

iMiss Tindall vas trained in England, and liad had 
wide experience at home and in Eg>-pt before coming 
to India. Active in organisation, she was chosen 
first president of tlie Trained Nurses Association of 
India when it was fonned in 1911, and under her 
guidance the school advanced in development; 
teaching was thorcniglily organised, and lectures 
given in English and in the native "vernacular ." 
The nurses wear white without distinction of class. 
In the lecture-room of the school are tablets whereon 
are placed the names of all who receive certificates. 

One of the earliest jieces of pioneer nursing work 
was thai of the Zenana Bible Medical Mis.sion, which 
has aimed both at providing English trained nurses 
for the needs of the medical service, and at training 
the native women as nurses. Its nursing field was 
taken up in 1SS2. when Miss Marston came with her 
sister, Dr. '< . Alarston, to die Im pital at Luckncw. 
She. Iiowever, was transferred within the year totlie 
Zenana work. In i.S,S;v two trained nurses. Miss 
Gregory, who was trained in Man( hestcr, and Miss 



Roper, were sent out. The latter was placed at 

Lucknow, ihcTi the only hospital of the mission, 
wnile the former studied the vemaeulars in prepara- 
tion fur the expected opening of a second hospital in 
Jknares. When this new hospital was opened in 
i.s.sS, Miss Gregory began the trainmg of native 
uomen there. Hers was a varied and useful service. 
t"r at the tmie this was written she was still connected 
with the hospitals of the mission, .sometimes directing, 
sometimes helping with the nursing departments, and 
always leading the way to new and improved methods. 
Other nurses in the training work have been 
three from the Manchester Royal Infirmar}-, Miss 
fiowesman, Miss Riley, and Miss Gran^ Miss 
Oeighton from the Illinois school in Chicago; Miss 
Hostrop, a Dane; xMiss Watson, trained in Liverpool, 
Miss Wright, in Derbyshire, ar.d Miss Pearse, 'n 
ilK' Edinburgh Royal InnrmarA^ Under those women, 
the training was brought up to an organised three 
yr;irs, study and examinations arranged, and text- 
hooks translated into the Persian and Roman Urdu. 
The mission has several hos])iials. The first Indian 
I'robationer to take the full course here was Hermina 
Caleb, wIk, i uluated in 1897. Although she soon 
married, she studied pharmacy and remained at 
'AMfk in one of the hospitals as compounder until 
!wo| Of forty-ddd nurses trained in ten or more 
years, nineteen ma -ried almost at once, which d(>es 
not look as if India would be speedily overstocked 
with nurses. Creighton has told of an inrident of i)lai:ue 
nursing under this mis.'^ion. which showsa high degree 
01 tortitude in nuv Indian sisters: 


A History of Nursing- 

In 1902, when the plague was at its worst in Lucknow, 
we built a plague camp. The huis, -nade of grass, were 
large enough fur two patients and, as it was intended for 
Zenana women, we had an enclosure made of reeds around 
it. I shall never forget the day wlien I asked for volun- 
teers from among our Indian nurses for this eamj). I 
could only give them two days to think about it, and when 
I gathered them all together and asked who was willing 
to go, making it very plain to them that perhajjs tliey 
would never return, out of the twelve four spoke and said : 
"We will take our lives in our hands an<l go." They 
made all prcjjarations in case they should not return, 
and. taking their oldest clothes in bundles, we silently 
walked to camp. For months they were in the camps, 
cut off from exery one, and what they went through 
would have made many an English heart faini. It was 
not only the being in ;i lonely place with the dead and 
d>ing; many times robbers came their way, with their 
strange custom of imitating the cries of wild animals. 
A gang we- • through the field one night between eleven 
o'clock and x.iidnight, when I was in the cami). They 
imitated jackals until the field seemed full of them. In 
anotiier camp, a native nurse, the only one on night duty, 
was attacked by a robber. Although he seized her bv 
the throat, she succecdc 1 in driving him off and sta\cd 
at her i)ost until the m.orning. 

The Sisters of All Saints took an important part 
in developing Indian nursing. In iS8.\, they took 
charge of the European (3cneral Hos;)ital, r.ombay, 
and a year later of St George's, the intention of the 
authorities being that thv'w work should form a 
centre from which wcll-tni; ,l:' nurses miglit he sup- 
plied to oiher institutions. In i)oj, St. (George's 
formed its own .staff, but in the Jam.setjee Jcjeebhoy 



Hospital in Bombay among others, the Sisters con- 
linuL-d to train not only Europeans, but also numbers 
t)f Parsee and xndian pupil nurses. St. George's 
formed a Nursing Association, and chose Miss C. R. 
-Mil!, from the Dundee Royal Infirmary-, as lady 
superintendent. Aliss Mill, who joined the Inter- 
national Council of Nurses at its formation, to re- 
present India, had had five 3'ears' experience in plague 
nursing in Toona, under the government, as well as 
ordinary work in England. St. Georg,Vs training 
i> for three years, while the nurses sign for four, 
.s:;ending the last on ihe private staff. 

'Fhc North India School of Medicine, founded at 
L'ldhiana in 1894 ^Y ^^r. Edith Brown (England), 
has done j'eoman's service in early training efforts. 
Dr. Brown wrote: 

Nineteen years ago when I came out to India, there 
was nothing which could be called irjrsing in the Woman's 
Hosnital.and itwas exceedingly difficult togct any woman 
' ■■■ ^wl of good f;nnily to enter a course of training. Sanit- 
ar\- work was oojccted to as "sweeper's work" and per- 
.-.nal care of the i)aticnts as "ayah's work." while there 
uas no appreciation of the necessity for accuracy or 
method in the giving of medicines and food. Some of 
t!ie ori)han girls were sent from the orphanage to learn 
nnrsmg, the reason for their coming being such as the 
1 'iliAving: 

"As she has only one eye and cannot be a teacher," 

"-. "as she is so liisobediet.t, I can do nothing with her*' 

":, "as sl;e iias such a bad temper that she cannot be 

■•■■i^ted in the school, because she beats the children." 

r'urther, they were sent to us at sixteen years of age, 

at all, as it was "not worth while to keep them longer 

246 A History of Nursing 

jn school, " and when they came they were physically 
not strong,' cnou.^'h for such work — were afraid of being 
awake at ni<;ht, and, if a jiatient were sijceially ill were 
actually afraid to <;o near her alone at ni^dit, so it may be 
imaj^incd our ditliculties were ^f'^t- After some time 
we got some European girls and a few girls of good family 
to take uj) the work, following the cxamijle of those at 
home, and tlii> gave a certain amount ot prestige which 
has made it easier. The presence of English nurses in 
India, too, has had much influence in altering the general 
atti ude towards the j)rofession. In 1900, we were 
jomcd by Sister Winifred Thorpe, whose influence has 
been great in In lia, and under her superintendence our 
course of study was raised from two to three years, and 
a higher standard of preliminary education was required. 
Nurses who have gone from our school have had respons- 
ible posts in government hospitals in Simla, Lahore, and 
Amritsar, and in many mission hospitals in North India. 

The Albert Edward Hospital of Kolhapur took its 
first class of native women to be trained as nurses in 
1890. They were hardly able to read, yet did excel- 
lent work, and their example was not without influ- 
ence among high-caste women. In 190; another class 
was formed and a better educated body of women 
then came forward. Ten of them, superior women 
in every way, completed the course of training. 

The Canadian Presbyterian Mission l)uilt its first 
women's hosj)ital at Indorc, Central India, in 1891, 
and worked .slowly toward nursing efficiency. For 
five years the nunsing of all the patients had to be 
done by their friends, but, in 1896, a graduate of the 
Toronto General Hospital, Miss Harriet Thom.son, 
came into the mission, and, in 1898, the first class of 



1.0 !fia 11." 

It i^ ' 

.... . 12.0 1 

I.I ,- '""— 1 

■-.... 1 








GE Inc 

— =-■ !r.", < (.HI »:■■ .(.... 




two probationers was started, vvi'th a native head 
nurse tramc^d n. a mission hospital at Benares no 

e ed Thr "' ^^^^^•?^^'"-- ^-'^- ^he other eom- 
Plttcd a three years eourse. took her eertifieate and 

-sappouu.d as head nurse in a native stat^W 
I : '• i he unuonn is a pink and v. huc c.heek with the 
he drapenes oi the countr)-. The also 
a ho.p:.a HI Dhar. Canadian trained nurses '.ave 
done excellent work in these eentres 

The American Evangelical Lutheran Mission 
opened Us hospital at Guntur, South India, in Sn^ 
Many obstacles had to be surmounted before natlV^ 
prejudices to nursing duties were finally overcon u 
U ell-educated girls regarded such duties as ver,- de- 
grading eonflieting with ideas of caste, and i^was 
nally decided to open a training school for Europ^^n 
and Eurasian candidates as an example. After 
laborious introducto^- work the school was started 
.n 1^99 with three pupils. Beginning with two years 
e course was soon extended to three, and a'eare-' 
teacv''""' ''"' ^''" satisfactonly followed 
Hdical nursing, materia medica, and midwifer>- in 

::r;;:' "'""• ^'"^ ^^"^^'^-^'^ demonstrationJ^.d 
Jasroom equipment. So well did all progress tin, 
; Apnl. I.., on the day after the annual Lm 'n: ' 

n mbe s of five classes being j,resent. Miss k' 

vanh H ^'^V;r""^^"dent (University of iVnn-' 

; v^inu Hospital), to whose ability and ..anK-stness 

o;:;^;:;':r'^^"r"^"'"^'"^"^^= "uvhavehnan; 

'lave more a])plicants th.un uv. ,..,,, ,.,1... ^^. , 


A History of Xursing 

conquered tlie unwillingness lo sweep, and the op- 
position to all those duties once considered degrading. 
The nurses do everything for the patients, and we do 
not allow a sweeper to enter the wards. 1 1 was ujj- 
hill work, but we have succeeded, and feel jjroud of 
our success." 

The I^nglish Baptist Zenana Mission had its first 
English nurse at the hospital at Palwal. but this 
service was more or less tentative until the arrival 
in February 1905, of Sister Duff, who held London 
Hospital and other certificates and had been for three 
years in plague work in Bombay, Poona, and Ahmed- 
nagar. She rounded out the course of instruction 
and added class work in special practical nursing. 
The ne.xt English nurses who came to the work con- 
tinued to build up, and progress was marked and 
encouragnng. The course developed to three years, 
and Indian gnrls were trained into excellent nur.scs,' 
yet when they first came, "beds, sheets, and clean- 
liness were unheard-of luxuries and ])unctua]il\ an 
uncoveted virtue." In the various ho.spitals of the 
Baptist mission trained nurses are j)aid as high 
salaries as teachers, and this gives them standing in 
Indian eyes. 

From tlie L'liitcd Frcriuin!) of Scotland Mi.ssion 
with its Mure Memorial Hospital at Nagpur comes 
the report: 

Tlic young girls over scvontet'n who are l;ikcn arc ir- 
responsible and require much sujKTvision. As a nilc, 
they marry at or before the end of their training. Tlie 
un(-(hicated women, if intelligent and suitable, make 
good nurses, though to train them is a task needing much 





t"..e and patience. Our Matron and nurse-in-char.e is 
■' ,f ' '" °"'- °"" '^■■'"•"'K. an exceptionally ,ood n^r,. 
, _^ .,u.te eapaUc of d.rcctin, and super' ,t™«nr he 

•an.;"; c" ten a":";! "'.^"'-- >■--• "- s„,,jec,s 
.i.,tr,nnents icl "2 '*-""""K>\ ''-"•iagin,,, ,„,,,„.„! 
a:id .nidu.fcrvP ■''■•■■ ""'"''-' "™l'0"'alinK, 
.^-.r< ":t^eer[;«rS'ZJi;^^::J -- "^ 

:;:;;r;;::;r:t,t:rn^% '-"-"''-"- 

;., 7 1- - process ot ujibuildint; is sroinL-- nn 


\u sin^S '" ''"' ^^ f"™^"l ""-■ As-socia.i.m 

a a confer .n'""™*"" "' '■"''"• fi-' P"Posed 
a confe encc ,n .yoj ar,d agreed upon in ,„„; and 

'.» body has called into bcin,. the Train, d Nurses' 
■ -c,a„on of India A j„uma, for self-expr,^S„ 
eid h v'™" " "-'"•*"•■" con,„„„,iea,i„ns, 
hu , 1, ""'"■'■' -^°"""'' "•'■ ''"''"'■ ""^ ^ccessfoli; 

n ;; ;;; ";'"■ ■■;"" """ ""^ -«™ »' '■»>-•",. 

> cram.. c(„rt, great in,petu,s forward is at hand 
K 3/';: '."■■•- «-'"J''«I by Mrs. H.hann.che; 


-":>£ uniformity in trainint 

VV.-I ' 


I ti 1' f , . 1 , . 


A History of Nursing 

in 1909, when, at a conference of the India Medical 
Mission Association, a resolution was })asscd author- 
ising Miss E. MacDonnell (superintendent of the 
South Travancorc ]\Iedic;iI Mission of the London 
Missionary Society and trained at the Edinburt,'h 
Royal Inhrmary) to incjuire into and report upon this 
subject. Miss MacDonnell's work was arduous, 
for the standard of training for native Indian nurses 
was to be itemised and comi^ared, and the pro])osition 
of two levels — one for the hospitals under the govern- 
ment and another for those under the missions — con- 
sidered. Her committee sent out a questionnaire in 
1910 and, to focus rei)Iies, put forth a tentative i)ro- 
posal for arriving at a uniform standard for the mis- 
sion training schools. Briefly, this called for an 
adm.ission age not under eighteen, good vernacular 
education (about seven years of sehooling) with some 
knowledge of English, regular entrance periods twice 
yearly, a three years' course with the subjects laid 
down for each year, and an agreement on text-books 
for study. Miss Mac Donnell further wrote: "It was 
felt that it would very materially help in raising the 
standard of nursing in mission hosj^itals throughout 
India if a nursing (li[)loma were granted, not by each 
unit, but by the I. M. M. .\. who. through its local 
branch, would api)oint examiners annually." 

The direction of effort of nurses in India is further 
shown by an editorial in the March Journal, 191 1, 
closing with these words: "We are working towards 
rcgistratJDii of inirses, i.e., govt^nment recognition 
of llu' -l.iius of a trained nurse. . . . To get rcL'ist ra- 
tion, wi" must have a uniform standard of training." 

The first deliuitc example of inciincnt n-gistration 



is sI.own in the Presidency of Bombay, where a cen- 

Bomh-iv Pro ; t '^''""'^ "^ 1909-10 under the 

T ' ^^^idency Nursing Association, to stand 

arch^e train.,, set examinations, and gi^e :n^^: 

i^mtor>. J he first examination held under the 
auspices ot ,his body was described critic.^- t 
Ml . Tmdall, in the Nursi., Journal of lnd]a for 
November. i,„. Tentative though it may llZ 
;lns must be regarded as an important event n^:^ 
i"K;^a beginning of far-reaching ehanges 

nvate nursing in India is largely confined to the 

-eign colonies there, and is chiefly carried on 

rou.h associarions. of which that ' called Ladv 

Mm o s Indian Nursing Association is the largest recent, and also the most comprehen iT n 

Hat It recognised and made use of existing or<^an sa 

--.amplifying all. and extending thc^^^SS" 
nas projected in 1906. In the report for 1000 
Mrs. Jessie P. Davies. Lady Superintendent of a S 
;;:-pnsing three assistant superintendents .tl^^l 
-^^M Sisters, gave some details, as follows: 

rt mav be interesting to note that, under special 

me needs ol the registered subscribers that tfu- 
applicants must be hvin,r ;„ r ^ 

.11 . i!\iiig in J.uropcan lishion -ui,! 

;■':,'.:",•;."","• ,';■■' ■ • ■'■"■ 

All nurses rnjjaL:ed for serv-ir- 


'in lUI 



A Ilistcjry of Nursing" 

examined as to physical fitness. Inoculation against 
enteric fever, which is now compulsory for all nurses 
comin<; out, is clone free of charge at the pathological 
laboratory of the Royal Medical College at Mill- 
bank, and the association is much indebted to the 
Director-General of the Army Medical Service for 

Association nurses arc also permitted by the I^ndon 
School of Tropical Medicine to attend the lectures de- 
livered by Sir Patrick Manson and Dr. Sandwith. These 
lectures include both the nursing of tropical diseases 
and the preservation of health in the tropics and are of 
very considerable importance to nurses going to India 
for the first time. 

In order to meet the criticism, that nurses must of 
necessity become old-fashioned in their methods after 
five years' private nursing, it was agreed that, if desirous 
to re-engage, they must consent to go through a course 
of three months' training in some recognised hosjjital 
ai)proved by ! lie central committee either at home or in 
India, and, at the termination of such period, must 
produce a certificate of efficiency. 

There is also an association of Indian ladies who 
are undertaking to do something in nursing education, 
as shown by the following editorial from the Nuniu'- 

The Seva Sadan, or Sisters of India Societv, has just 
closed its second year. It is an association" of Indian 
ladies who are trying io build up a sisterhood of women, 
who. irrespective of caste or creed, shall devote themselves 
to i^hilanthropic work, niu. h as Christian dcaconcs-scs do 
in other lands. . . . 

The Sadan has eight i)rol)alioncrs in H( 

)mhay under a 



--I vill ,ive her ^.vi^'to i";"; ';"■' '^' "'^ «-^- 
^■■■->e to ,c.t a place u-h.r' L '. ''^^\ '?"''■- '^ oHicers 

J'>cu,r and train their ou-n nurses "' "-"'^'"^ ^^^>' 

Oneoi the friends of the T-'o,-;.,- 

^^"^oi^'-c:— --F--^«^*t■- 
Indian hospiial, ll,„„„„ connection ivith la™. 
'- '!.< . una i " 'roT'"' "="™' "^"'"-*n 

Tu ^ —.a,, iiuspjtal tor 

[he report reads: -U'e want the 

to f)rin<r tr.,,.,..! "- 

P"Wi^ to realise that, to n^l^jr"'^ "''''""^' ^^^ 
the same ideal of seri-ice an,? '^ ''""''" ''^''^ ^ave 

^oundin,<,^s. u-here, prartic^l'lv J,.'''^^' ^^^^™ ^^^nJ-st sur- 
o-pies their n^incl^Tr^^tHhc" ^ M '^^'^ ^^'™^ 
^•'■';^P'n^' a true nn'ssionary spfrit W ' '""' "' '^^- 
makm^r the best use of existin ''''' ""^ '""^'^^^'"t 

a <HlTerenee betu-een ins Uu "'sT""''^' ^"^ ^'^^ '-^ 
!'^^tionsandturnin,.outH4rtr ""' ^'"-^'■"•^ "^-"- 

;-^<'ed to the ideal of ovi ^^J'^^'"-"^-' --™. 
''-nn. ' the toreh of knou ^dl^^^^i'l^f ^T "7'^^^' ^"^^ 
■-'"'1 spiritual comfort all over thk ,"' "^ Physical 

' ''^' all-embracin. aL-enc -^f / ?"''™^ '^^"^^' 'hrouj^h 
^^'^- ^Jo not dunk the r-r? '■'"^'^^''^"^^ "^-d-vill.-'. 

hi^h motives oftrvtS " T' '"^ ^^^ The.,o 

i-rai„in, sd, :::c^^^:i: -;::^-^^^. -^ound 

"-kec,,v in H,e superintended "'nur- """' ^^ 
T^hey form the idc^al yvhi<-h is sof t r """' ^^■'•«- 

^-rls who take up a train", "rl!"^"':^ ^" ^'^-' Indian 

■■"«'■' ^"^T may have 


A History of Nursing 

to make nursint:; their means of livelihood, and if the 
Sadan can send amonj; them j,'iils who already have 
these hi<;h aims, there must be train on both sides. ■ 

The outline here given may, it is hoped, bring an 
impression of nursing in India before the mind, but 
by no means does it indicate its extent. The lists 
of membership in the national society show fifty or 
more hospitals, man\' built and supported by the 
government, others expressing the munificence of 
wealthy Hindus or Parsees, as well as the mission 
hospitals. The women holding executive posts in 
these institutions are as yet pre[)onderi'tingIy English 
or American; one Indian nurse's name appears in the 
column of 1910, Lhat of Rosie Singh, trained in the 
Memorial Hospital at Ludhiana and holding a post 
in the Sarah Seaward Alission Hospital at Allahabad. 
Rut in the future, Indian nurses should and doubtless 
will come into membership in ever larger numbers. 
At the Trained Nurses Association meeting in 1910, 
the question was discussed whether or not there 
should be a separate branch for the Indian women. 
Miss S. M. Tippetts (Guy's Hospital), Miss Tindall 
(Metropolitan and City of London). Miss Steen 
(Royal Iniirmary, Edinburgh), Mrs. Klosz (Johns 
Hoplvins), and others in the forefront of Indian nurs- 
ing affairs took the just and right position that true 
professional unity must be their aim, and the Indian 
nurses be encouraged to develop into organisation 
work, not by themselves, but all together. At the 
same time, the superintendents' papers and discus- 
sions dwelt upon the enormous difficulties sun'ounding 

'Nursing Journal oj India, Oct., 1910. 



spoke of her to thn „,. ^'"'"^'3. Miss Tii>pctts 
following terms " --nation in ,y,o. .„ the 

Association oVZsrSun. "'=^f "'"" °f' «^"- '"= 
'-.ottheTta,„::i^SS4TS"o':S= " '"''--^' 

been a hcav, t'l^:; ad'd^^lol LTa, ^Shl":' "'^1 

-y bas.s and b.o ; t: Z' ZT^'^'^'^'^ -'-'-'- 
standard ot nurs.n, a home "X'-r,-""''""' '" ""= 
l-opc, that the assoriat o„r „ "'"'"■'*■ ""' "''' »!' 

of work and cha ae ^ 'a m;" ,f ' =" ""■>■ "'«=" ^'-"ard 
'!i:,t thov will help and ,r '" ""^ of India, and 

•-■;-re ;veii.„i,,'; ,i"::,rtX:r;:" '^^- ''■"'-'"- 


can never fonrof 


norpcb splendid work. 


A History of Nursing 

and her !iame will ever call forth our admiration and 


Japan. The recorded histor>' of nursing in Japan 
begins twelve hundred years ago with the legends of 
the empress whose figure corresponds to that of the 
holy Elizabeth and other nursing saints. A transla- 
tion of her story was brought from Japan by Miss 
Wald and Miss Waters of the New York Nurses' 
Settlement, and runs thus: 

Over twelve hundred years ago there lived an empress 
whose name was Komio. She was the wife of the Emperor 
vShyomu, who built many temples, and brought many 
sarrcd objects from China and India. She was endowed 
wuh a very merciful and charitable heart. She estab- 
lished two charitable institutions: (i) Ilidcnin, a place 
where orphans and aged people came to be taken care 
of; (2) Seyaknin, a place where the poor were provided 
with medicines and necessary things for the sick. [A 
charity hospital.] With the permi.ssion of the Emperor 
she built a house where jicople came to be bathed, and 
sent word to the near-by towns that the Empress herself 
would bathe the lepers. The number [to ])e bathed by 
her own hands] was limited to one thousand. One after 
the other the i)atients came, but when the number 
reached 999, there was a sudden stop to their comin<.^ 
The Empress was greatly di.sappointed and wondercvl 
why there was not one more to make u]) the number. 
Finally there came a very ragged dirty man, whose whole 
body was covered with ulcers, of which the odour was 
enougli to make those sick wlio were near by. He 
stopped at the gate and asked those inside to let him in. 
But he was so filthv that the custodian refused to let 
him in. The ragged man still begged repeatedly to be 



admitted, and finally the word reached the En^press and 
The leper was Ic.l to the bathroom by the Emnro.. 

-i'll nl transformed nito a very perfect bein.r a, 
•---^hcd. she asked him who he wa . Then n 'a loud 

heart or only to gam the praise of the people " Then he 

ode on the purple cloud and vanished aJay. So bright 

a hght rad.atcd from him as he disappeared hat the 

ii^iu or onght; ban— mountain.] ■ 

From the day of the merciful Empress we come to 
•nodem t.mes, convinced that her stor^- is an emblem 
o. the mm,strat,ons of gentle, delicate Japanese 
".men to the sick and suffenng, even though they 
uero not recorded or performed in pubhc. ^ 

Ihe Charity Hospital in Tokio, one of the best 
I amy hospnals in the countn-, .as establi hedt 
'"*-'. The first training school in Japan was that 

"ho. oarl5 m that year, was sent by the .American 
■y a Catholic Father at H.tnn, T V, , ' ''" "'■-■'""ari^s: 

^-».na,v, i„ ,s„:l;" tn;.- 1 R- iirs";^ ""/"'"'"" 

f^'iK'l'sh missionaripc: ^t v \ ■ '"*-" ^"'' -^''ss Knott, two 

by Count Shigcnubu Okumf ^Fn , f '' '" '''" ''"'"■""■"'• ^°'^P"^^'i 

«- wntten J,;:!;' ^ M' ' wIm:;: l^^" l'^ ?->' ^^ ^'- 
> uJ.. IV. — *.-• ' "" J -;-"<■>-. !>, lin-mi. 

258 A History of Nursing 

Board of Missions to organise a school for the training 
of women nurses in the Doshisha Hospital ,n Kyoto 
Beynnmg with the tiniest outfit and aceommoda- 
oions, but with a group cf well-educated girls and 
marned women, the school graduated its first four 
pupils m June. .«S8, and its reputation had so grown 
in; he meantime that the second year opened with 
thirty pat:ent<, new wards, and a home for nurses. 
M.-^. iMchards stayed for five years m Japan, and 
atter her departure the school came under Japanese 
management.- Her first printed mention of this 
work was mad ni 1902, when she wrote: 

So it came to r.ass that the first training .chool for 
nurses inT-pa. was organised and, for a time, controlled 
by Americans. At first, like all new movements, it was 
carcfullv watched to sec if it was rcallv Just what ^a 
Hanted to meet the dcnands . . . There are no people 
more quick to recogmse merit in anv enterpris.. than the 
Japanese, nor can a people he found who u ill „,or,. cjuickh- 

ca eTul,:::' r'^, ^^".^^ °^ ^^^-^ ''-^^ ^— -t were 

d;:srr w^rr'^^'r^i^^"^'^"'' 

anporunt school was opened, having for ks patroness the 
Empress herself^ It was organised in connection with 
the Empress^ Hospital, and. of eourse. received the 
sanction and support of the government. . Th 
Japanese d,d not consider all methods in use in foreign 
trnmingscools perfect, and decided to improve u o!; 
them If training schools were to benefit women .t 

Ind "r ' T ^^'^ ""' ^^"-^--' '-titutL 
and pui„ls ,n ,h.m should have similar advantages to 



those in other schools; they must be treated as scholars. 
and, therctore. an entrance exa.nination was required 
riie nurses were to be seIf-sup„ortinK^ the hours of duty 
must be fixed, and those for study, lectures, and recha- 
t>on must be ample. Most of the applicants wen gradu- 
ates from ,ood schools, youn, women of hi^h purpose, 

riurcHi '"'''"^^'''" *° '"''''''''^' ^""^ '" '"'^ '""''^'^ »^ 

Miss Richards's work laid the foundations for a 
fnendly feeling between American and Japanese 
nurses. Smce that day many Japanese probationers 
have come to America for training, and others, 
trained a home, have come for post-graduate work 
A vivid description of the organisation and ideals 
of modem Japanese nursing was brought by Miss 
Ifagiwara to the London Congress in ,009, and is here 
repeated almost in full. It was prepared ,n the. Red 
Cross he^idquarters in Tokio under the direct aus- 
pices of Pnnce M. Alatsukata. president of the Red 
C ross Societj- of Japan, to whose kindness and interest 
•n the Iru.mational Congress of Nurses we owed the 
'nendly participation of Japan and the presence of 
several Japanese nurses, one of whom came fn -m f'aris 
as a delegate from her country. The war between 
.Iai>an arid Russia had brotight the bnlliant achieve- 
ment, of nurses into world-wide r.nown. 
a racting the interest and sympathy of those in al 
her cotrntncs. When, therefore, little ladie 
arne upon the platform beautifully dressed and cov- 
e cd with decorations for valour in three wars the 
sttr and interest were lively and cr.rdial. Thev 
qmckly won all hearts, and Miss Ilngiwrra the 

■ Amrn. an Journal of Xursing, April, i-;,,.., ,,. ,,,,. 

260 A History of Nursing 

delegate, was one of the centres of attraction at the 


The work of nursing' in Japan has no such old history 
as in Christian countries. The association of Christian 
Sisters is unknown in Japan, not because there was no 
charity in the country, hut because Buddhism— Japan's 
chief reli^non for centuries— laid much K^reater stress upon 
helpin;,' the poor than upon nursing the sick and wounded. 
In addition to tliis fact, up to very recent years, social 
rules as to the separation between the se.ves were so strict 
that, outside the sphere of family rclationshir,, no idea 
could ix! entertained of a woman tiikin^^ care of a sick or 
wounded man, unless for jjay. and mercenary nursing 
has not the same element of charity and self-sacrifice in it. 
The art of nursing by women was first introduced with 
the an of treating patients according toWestern tnethods. 
and nurses are now being employed in great numbers in 
all the hosi)itals, public and private; and considering that 
there are in the whole of Japan 102 institutions for their 
training, besides those belonging to thcRedCross Society, 
we may presume that their number is very rapidly in- 
creasing. In this i)ai cr we shall not attempt to describe 
other institutions than those of the Red vSociet\'. 
Sc\eral local govermnents have within recent years en- 
forced regulations according to wln\ h only lIiose'(iu;ilifie<i 
for the work can make nursing a profession. Hut our 
present purpose is (o introdu(-e to our Western sisters 
the Rcil Cross luirsc.; of japan. 

The I4,()(K) nurses of our Rr.l Cross vSociety are in two 
divisions, namely, voluntary nurses and relief nurses, 
whose duties Iiave been developed ujion the folKuving 

The Japanese Red Cross Society collects contributions 
from generous and patriotic people, and. with the capitil 
so realised, trains and exercises the relief pcrsomiel oi 


26 r 


sexes in time of 

classes of socirlv But „nri .u ;/'"""- ^"^ hik'hcr 
most St L . bv tl T"' """■*^'-^' ^'''^^^' ^^^^^ ---' ^--^d 

......1 ivou„,k.l soWht ,1 ""■ ''""'•' "'■ "'" *'^k 

ur societies, an association of ahout tu-ont,- 1 r 
lorinci? u-itl, I),--., * • '"'-'"'• "-^^t-i'V lathes was 

n.Jo;:,ri?rT"'-' '"'.'7'; ''"■■»'''«■ -■'''" 

|.r«idont, T "''"'"' '••'"«>• f"r "» vice- 

theeffcct of d 

ispersini' a 

II .t,.. : i 

<v.ii t/I 

nuaiiricss connected 


A History of Nursing 

with nursin;;;. but also that of breaking through the 
custom of our ladies leading a life of seclusion and retire- 
ment, and gave them the imj)ulse to come out and take 
part in the work of ])uhlic utility. Tliis is the origin of 
the Volunteer Xursing Association in Japan. Its sub- 
sequent development was remarkably raj^id, and it 
rendert'd great services in the Chinese war of iS()4. the 
Russian war of 1904, and the Boxer troubles of iQoo. 
It now forms an important auxiliary force, side by side 
wiih the relief nurses to be next described. It has its 
central eonimilk-e in the headcjuarters of the Ja])anese 
Red Cross Society in Tokio, and forty-four branches in 
the diiTerent j)rovinccs of tne Empire, and counts at 
present over ten thousand two hundred members. Not 
a \'vw of the foreign residents in Japan take {)art in it, 
and it is our great pride to count among its associates 
Lady Macdonald, wife of the British Ambassador, and 
Mrs. Richardson, now in London, widow of tlie late 
Colonel Ricliardson, who had fought for his country in 
South Africa. 

Let us now pass on to the relief nurses of our societv. 
The name demands an exi)lanation. Ail t he persons that 
the Japanese Red Cross Society sjjccially trains in view 
of service in time of war, according to the regulations 
authorised by the army and navy, i-oii.;titute the relief 
l)ersonnel, and the nurses that form a j)art of this per- 
sonnel an- relief nurses (the volunteer nurses just de- 
scril)ed form no part of relief nurses, because they are not 
included in the relief personnel). The relief nurses are 
taken from among general candidates upon cxaminalio.i. 
and are subjected to special training, at the expense of 
the society, either in its main hosi)it.'il in Tokio or in tlv 
hospitals belonging to its local sections, for the term ot 
three years, during which they arc called the "jjroba- 
timuTs" of the Japanese Red Society. In provinces 
where im Kdl Cross hospitals exist, arrangement is madt! 



.•anisalion of the amy and nav Th. ■ '• '' °'- 

- lK.Uvco„ .ixtecn a'„d th ny Jr of 7. rf"'' 
nTirri/.r< TX'' I ■^ vi^ai^i ui aire, and un- 

■nou-n in fai)in \ - .1 , ^uroi)e. is almost un- 

;•;> of I-tnotic idca.s. to -U ^^^^l^^ZTu 
•iH' niom,. of acquiring ,o„,c art which can.; 

f T only those ivith an ado,,,,!? , ' "' '^"^y- 

admitlcl Af„, ''" """I"-"'-' amount of education are 

"...rwriuef m:; rr v "^' '-""' "-^- " ■^°'- 

Principle, and respo^ to the 'c u";"' '"'"■"' '" "" 
-iety any tin.e d.'.rin, the ll^r, ' 1 !::,«.;;' /f 
•»>«J fron, the date of „radnation. Trav, i, " ^i 
■■"..1 Planes arc paid to then, «he,,cve . ' If 

-«ty and durin,. the tin,., of .I,eir":rvi;e '" ""= 

..foncy' ar"„!;r;h:; ™""''i '^' ■''"'•"' ""» If- "-t t,.rm 

."'i*- yed.r and the second term of two vcnr^ tl, . c 
1^ ac%otcd to theoTvtical nistruel.on and the 1-ifter 
t > practical training. The Iheorefi,^-.! • 
sistsof thenntlin r '"^"^'"'^^ '"^truction con- 

-n,i^ ;?^ he rf o"' "^''''"^^- "'^^^^^^^ '^^ -"--. 

roatrnent.massaKC manipulation of 

J"ents, iniprovioca Lrcaiment ot tl 

lllSt fu- 

ll' wonn 

(led. hy, 



A History of Nursing 

outlines of i)harniacolo,<,^y, and transport of [latients. 
Also, the " Instructions to relief personnel," cthies and 
" Moral counsel to nurses," " Rules of saluting and otiier 
etiquette of the relief coqis," grades and denominations 
of military and naval otlieers and their unilorms, inter- 
national treaties concerning the Red Cross work, a sketch 
of the history and organisation of the Japanese Red Cross 
Society, and the organisation of its relief work in time of 
war, are taught as side studies. Lessons are also given 
in the treatment and feeding of patients in military 
hospitals at the front, the disposal of deceased jjatients 
and of their wills, the service in the base hosi)itals and 
the fortress ho-^pitals of the army and in the hosi)itals of 
the navy. Foreign language is optional. A glance at 
the subjects tauglit will show that it is only the well- 
educated daughters of the middle and the higher classes. 
possessed of intelligence above mediocrity, that can asi)ire 
to become relief nurses of our societv. 

Those that have shown themselves to be excellent both 
in theoretical training and practical work are subjected 
to a course of si)eeial training for another si.\ months in 
the Red Cross Hospital of Tokio. after which they are 
once more examined, and, if succi^ssful, are granted the 
diplomas cjualifying them to be head nurses of the society. 
During training the jjrobationcrs are obliged to live 
in the dormitories under the strict guidance and control 
of their superiors. They are Tiot permitted to di.scontinue 
tlu- study at their own will, unless it be on account of 
illness or other dis(]ualifying circumstances. 

Suice this system of training was begun in iSqo, 4067 
students wiTe achnitted, of which ;,i()() graduated, 4H6 
died or had to give up the study before graduation, and 
4JI an- still under training. The relief nurses of tlie 
society are free to marry or to adojjt any mode of life 
thcv choose, pmxided thiy rcuKiin failliful to the v(av 
and keep themselves ready to respond to the calls of ih.e 



Ih.s dc,,artmcnt, which looks after the « 4„ , T* • 
mates a„>, deducts a small portion of he ^ e ■ i e^T" 
; ■ .ay the expenses of their protection an co, tro" 

Service m Time of Peace and of War. 

of '^tacT'be'TdTr ''"■"° "^'■" ■""'^-"-■^ "' ""- 
1 <-,icc OLvond n'ceivin.^ instruction -.t ,i, , 

;';-i".s or the association and voCjl'^ir^^^^ 

; ' -k or vsu.n, patients when there is a sudden necc 'sitv 

co„.,uencc. of earthquakes, inundations. ^^^^^ 

-' ks c^i er re^ V T' "i" ''^ '^'^"^^^ ^'^-'-•'-^ ^^ 
s.oned , r """" ''•' ^'^^^ ^^^^^-'ation or 

s. ncd l.v the nnhtary or naval autiiorities In the 
<■ hmo-Japanesewarof 180. f,„-;n-r.„, 
-■ "■™'. incl n« the 1 n^ttet J ' ^ ,1^ f""'" 

.- uu e 1, la." f ' ,-'■ ■" ""•■ '"""'=' ■" ^l'^- -^ri'-'V 

t'c. Also, two of the o!d 


est ineinl 

HTs ot theassociati 

-.M..unna. wluch was the base of 



A History of Nursing 

of the army fiKhtinj^ in China, and became directresses 
of the relief inirses servin-,' in ilie military hospital of 
that place. Other members, a., of them ladies in the 
highest position, \isited the military and naval hospitals 
as representing the wholo association. These visits to 
hospitals are regarded as a matter of great importance in 
Japan, for among the soldiers are men from the lowest 
classes, such as labourers and co(jIies, who can never ho])e 
to converse with lailies of the highest position in ordinary 
tmies; but when they are admitted into hospitals as sick 
or wounded soldiers they are sjjoken to and consoled by 
these ladies, and the feeling of honour done to them 
certainly does them good. 

In the Boxer troubles of 1900 the sick and wounded 
were not numerous; but the ladies of the Voluntary 
Nursing Association i)aid visits to i)atients, and also 
triefi in many ways to encourage the relief nurses working 
in the hospitals and hospital ships. 

But it is in the late Russian war that the Voluntary 
Nursing Association, hitherto playing rather a decorative 
part in the whole organisation of the Red Cross work in 
Japan, showed a great activity and proved itself to be 
an important factor in the real relieving force of tl.e 
society. In the seventeen i)rovinces of the Empire, the 
real work of nursing in the base hosjjitals of the army 
and in their sections was actively assisted by the members 
of the association living in the resjieetive locahties, and 
in every landing-place and railway-station where the sick 
and wounded soldiers returning from the front were made 
to rest and take meals, rest-stations were established by 
the local committees of the Red Cross Society and worked 
by the tnembers of the Voluntary Nursing As.sociation, 
some changing the l)andages or washing the faces of the 
soldiers, and others aiding theiTi in taking meals. Others, 
again, jiaid visits to hospitals, .'istrilnited presents to 
patients, and even occasion.3,Ilv ',^ ive ontertai'iments. in 

nts to 

>n f u; in 


music and other a,nusements in order 
iOT'^et their sufferings 

to make them 

•" '■- ft.nd of the unScruIki,,!"'" -^/,"' L^-tt"''" 

P<^-ia!ly noted is thnf- ^ii ., , "^ ^" ^'^ ^'■'^- 

in the'r ,)oek-c>t<. w-, - ^ Japanese sol.h-ers 

b^> placed by tlio soldLs , I, . ^ ""'''''•'''' "'"' "'-■ '» 

lutelv sure lint tlu v t ?"■' "'"'"-''' '° '^'^ 

» that .1 dr ttn 4 ■ ""''7'-^- *-^">fcn^'J and rolled, 

\ol„ntary Nursile \ oe ■■■''"°" "'"■ "■>■■>' ^*'^'' 'he 
Tuo hundred aTdll/nr '" """""^'ke the task. 

Ki.>ce.e.;ti*tln^,:r::;.rr;T,'''^ ':?':""' 

l-"l to act a-i a ■ r,.,i f- , ' '"^ ""> ™"M "ot 

-« >he,r^i -ees . X' "V" "" ""'^ ""^^^^ -"-^- 
a little ,„ tlK t,," ° ^'TT' ""'' ^"■""f'""^'! not 

«.-e tite. i;r;:;;,r;;; iirre^ ri;z^'°"'f °"' r 

A"ain nil fn, -• i , "^"(-itiks dre and swon s 

.'■■^rn" hf;. z t™ ,;:r:;;'r' •^'■"""■■^ ""■-*' ""^ 
' -p"- .hrott,,, tS' rjr™:-:-'"'""^'-" 

station. per.o,ly :,;,,' ■:;;■"' ?, "™ '» ''- -""-.v- 

t' then, ,«,ien,s'^° ; : . r''''"f- ""'^ -''^•"'™'«1 
.. '^ - ^'.'l"- "'-"Ic I'Mli.'m.sclvc^andtheladiei 

the Court. In this war 

2S1 I ni.Tn!... 

'"' """'"^ ^^-=-«°" a.;ist„rt,K:^:d :.:^J:z 


A History of Nursing 

in the different localities, 79 of them were decorated for 


e cr a ,reat vnhU. ealan.ity takes place, ind n.any cases 

Kcd Cross Socely concerned calls to^etlier the relief 

rmr^^nder its jurisdiction and despatches them t;^; 
scene of disaster. A,,.un, when the Imperial army has 

^.th It the rehc.t nurses, are also called out for purposes 
of man.euvrn., in eon.bination with the troops. ' Be id 
these extraordinary calls, there is a roll-call once in ever; 
two years ,u order to ascertain that the nurses whose 
names are on the list are ready and fit for service nca^ 
or national emer,vncy. The occasion is also uti "ed 
for KHvm, necessary instrtictions to the nurses. A 
head nurses are called once durin, the fifteen years o 

h m If ;f "^ T'"'''r^' '" ''''^ ^^^"■^-- °f training 
them n he work for which they are intended. The 
wnt of calls ou,,ht to he served to the persons addressed 

Vl^tT^' ''• "^^"-— • ^^-. they are subjected 
to ph>McaI examination, and u f.nmd unfit for service 
m time of war, their names are struck out from the list 
Should the nurses be behind time in resnondin, to he 

o vow "^;^lT'°"', '' ^"' ^'^^' ""'^ ^^-'^>' "f - breach 
o vow, and treatc.l as such, unless a certificate of ill- 
ness, signed by a physician, or a document establishing 
inevitability of the delav, is produanl 

J.^e" ^;:;7^'^'-^^ ^\'^ ^-^ year, the president of the 
Japanese Rd Cross Soeu-ty has to draw up a renort on 
the preparation of the .society for .service in time of w.r 
covenng the period of twelve montl.-. " - - ' '' 

A „ ^t 



-and ord,rs arc .siuc-d bt ?h '™*' ''""^ '°'^'"" 

r-'lirf corps „f ,hc s"cfc,v- i ■ "''"T"'' '" "^"--'^ "■« 
■'( preparation, iCZLl fV'' "■'"' ""^ "'"" 

-'-'■■-•d are ca,W " j\. rtii "' """' '"'"^ 
after the conis have once h r '■'■'""">' °"'""-s 

<all.. are madl Thcscr °" "™"'' '="Pl"™entary 

"--".hthetreaSt r™:rir\T'^^ 

■he societv, torn,, „f c' I o"' * '*'''' '''■'"'"" "^ 

■•'"•ay in t,-;„e or Poa:i';:!ad t bTfi.sir; -ththr^^' 

:.:s -arr^rriH;:'' ^-^ -*- -" "• - 

-ana„omc„t of a&i'r, "urin 1""."'"°""'* '"■■' "- 
-ost the recent wthl 7 T f"" "^"-'""^ »™ '»'™d '» 

■'■•^0 the ca>I,„, ,■„ of reserv::fort f: t Zf ■"■■ " '"'' 

r"-"''— --='C'=■^- 
"icrchantmen tctnoor .rilv ,"/'"=. """"y "dinary 

■'< •'ioroh^f^SnLatronricrf:''' -^r '"^ -"^ 
-"'" ,de into i^-r;':, ;:' :i°;,i::.:-', '""■"*■ '- 

ones, and (.,nt)lov tho,„ • i '^^""y^'"^ to make greater 
•'H^ front Mvl o ,V '"'" ^"™^'^"ts are sent to 

--n;'t:::i:;;;s:z°::^-;;— -T -<- 


er the 

army nor the navy h 

laio at tij(i 
y rtas nurses, and 


A History of Nursing 

for this indispensable element of j^ood medical and surgi- 
cal treatment, both depend entirely upon our i:ociety. 
And the way in which our relief personnel is employed 
as ijart of the medical orp:anisation of the army or the 
navy is special: they arc never permitted to work inde- 
pendently, but are placed under the direction and control 
of medical officers of the army and the navy, and in many 
cases our personnel work with the government personnel 
m one and the same ward. In each hospital ship there 
are only one directing medical oiTicer and one or two non- 
commissioned officers representing the army, and all the 
rest )f the medical staff 's composed entirely of our relief 

0{ the 152 relief corps the Japanese Red Cross Society 
organised and used in the Russian war, 102 were relief 
detachments formed of nurses, 14 those composed partly 
of nurses and partly of men attendants, besides the 
personnel for the two hospital ships of the society, 
composed likewise of nurses and attendants. The de- 
tachments were used by the army and the navy in the 
following way: 77 detachments in twelve base hospitals 
and one fortress hospital of the armv, 4 detachments in 
two hospitals of the na-y, 35 detachments in twenty 
hospital ships of the army. The number of nurses 
employed was; i directress of nurses, 255 head nurses, 
C526 nurses— total, 2782. 

As the nurses belonging to the society were insufficient 
after the battle of Liao-yang, 829 out of the above numb.T 
were recruited as a temporary measure from among the 
nurses trained at the Tokio Charity Hospital, the Medical 
College of Okayama, the Kumamoto branch of the 
Japanese Sanitary Association, etc. We have also to 
count the 99 relief nurses attached to the 20 rest-stations 
at landing-jilaces and railway-stations. 

The total number of the sick and wounded soldiers 
cared for by the oiehtv-one d'.^t.-irhmonf.; -.-r-.-^r-..-, -ir-. i-i,- 

Japan ^71 

"uectious or contaj,nous diseases and IT. 

:Ft:=S2— ^-^ = 

placed ■„ cha.,0 of «,.h .vards. a. a n,l \ 1"^? 
hospital havrng been established .n Mat-,u-,m, r ,\ 
w;n,„ded Russian sailo.. v.etints of t'^- b tr„ ' X ! 
Vn (Chemnlpo). Ihe Miniver of the Xavy entrusted it. 


■'"""« '^'^"y ^™'m,tivo n,„nths ,vas the hardesWor 


In this war, 30 nurses out of tho totol oK 

iJi^tTn^^kr-^ ---" -"-."on^aZrof 
iiuic.^b ana otner causes nmf ->--,- 



The above resume will have shown the aefual state of 
nurses and nursin, in Japan as far as the R d r' s! 
Society IS concerned. ^^^^^ 

In conclusion, let me say a few words with regard to 
the special trait of our relief nurses on ,,4 '"/^^^^'-^ ^^ 
relies most for its work m t me C uT'' T"^^ 

l^intinwhich they the ,:::rse/l:^ 

tncs, that difference must come from the f-ict th.f th 

le navv 
iployed for relief work in th 


IS trnr> fViif +1, — 

c case of public calami- 


\ History of Nursing 

tics as well, but only so far a.s there is surplus force, and 
then only as a means of exercising the relief uor!: m time 
ot war At that time they are incorporated with the 
medical organisation of the army and the naw. as al- 
ready said. To our knouledge, there is no 'country 
except Japan where only relict nurses-that is, thoroughly 
trained nurses bound by oath to serve the society-are 
relied upon by the Red CrossSociety in preparing for work 
in time ofwar, ■ Voluntary nurses are used only as an 
auxiliary lorce. because it has been found difficult to 
t-cep up the rigid rules with volunteers, rules which serv- 
ice m the arm. and navy requires. Nobodj- is obliged 
to become a relief nurse of the Japanese Red Cross 
Society, but ,f once admitted and trained as such, the 
rdief nurses arc bound by to conform themselves to 
all the conditions of service, however strict, which the 
society imposes upon them, and that with military 
exactness. Prom this arises the distinguishing charac- 
tenst.c of our nurses, which may be summed up in the 

They pay attention to the minutest rules of correct- 
ness connected with their unifonns. postures, ways of 

Tnu'^.u "''''"''°'' ^"^ ^^ conversing with their 

equals; they are scrupulously clean and tidy, but never 
coquetti. . They are always taught "to'respoct tl" 
patients, but not to become familiar with them." so that 
they never converse in a low voice with patients or cor- 
respond with them in writing. They do not accept 
presents in any form from the patients or their relatives. 
unless ,t be th.ough the medium of the society. It i^ 

Zlr'fll '^f ,^'^'"^' absolutely well disciplined an.l 
correct that made Japanese military and naval authorities 
decide to use the Red Cross nurses in the hospitals of the 

Re/cioss'l ■'■;"''" "" '""" "' '"' """'^"^ '^^^'^ «'«>• AH other 
KCiJ I «.Kictics accent, untr.ui,,.,! vulunteLTs.— Kd. 



army and the navy, and 


nuimlL,"'",." ITS,".",,:;*;;''' ""- r ""' ^-■•^ 

><>nsta„t!y Molding u,Z ui , 'T '""' '" '^'"" ''>■ 

H r then 1; h?!" """""'■' ""'■'' '-■"■■■• th-. HK,,. 
;; . Ion,,. tra,„,„K and respond „,■„, „,„„„ ,,:, '^ .^'^ '= 
"f the- «1,„K... *■ ° "'" "'«'''>• »l'™- "><-• intent 

haughty a,Sr,oMr „'u;™:^r'" r:i" ■' "^">- ■^'^ 

ti...n, ron,c„„.ri„« that to n^o t ^ .or":,?;',"' 
"oundcd is a dulv touards the state ,vh; ' '" 

imposes upon >o„," '° "'"''' l'^"notlsra 

r™ fheT/'na™;""!-" "™°;™'^<^n"^te themselves 

irocfy. and should .h'ey'^perfU th s vo^^„S '.^ 
b^evolenee (towards the patients) and loyalty o the 

Vol. IV. — 18 

inmg about 




A Ilistoty of Nursing 

under the .shower of shells and bullets. It is a n^atter 
of j^reat honour for a woman to he able to take jjart in 
service in time of war, and only those that follow in 
ordinary times the counsel as set forth in the above 
para^'raphs shall be able to keep this honour intact. 
Hence it is that, over and above the technical studies, 
a behaviour in <;ood conformity with the moral ideal is 

While this paper relates onl}' tc Red Cross nurses, 
who set the pattern for the countr", there are many 
large city, county, and private h'v itals in Japan that 
train excellent nurses for work in civil hfc. Their 
courses are from two to three years. 

The first hold innovation in army nursing -v-as 
carried through by Surgeon- General Tadanori Ishi- 
guro, who was in charge i)f field sanitation during 
the war with China. He decided to call nurses to 
the Reserve hospitals, and says of this eani])aign: 

For the first time in Japanese history, by utilising the 
services of the Red Cross medical staff, "female nurses 
were cmploye<] in the Reserve hospitals, these nurses 
having been trained for years at the Red Cross Hospital 
in Tokio. under the supervision of Dr. Hashimoto. This 
cmi)loyment of female nurses met with loud opposition 
from some quarters because of antiquated notions re- 
garding the relative status of men and women in Japan, 
but I stoutly maintained my original position and em- 
ployed the Red Hospital in the military 
hospitals of Hiroshima and elsewhere. The results 
•amply justified my course of action, for all these nurses 
proved an unqualified success.' 

» Reports, Int. Cong, (jf N'urses, London 1909. 
* Fifty Years of Sew Japan, vol. ii., p. J17. 

Japan 275 

.a/cTofA'r' T' ''' ""'' ^'''' ^"''^^" -^ Japan 
said of AIiss Hagnvara a-^d the London Congrels! 

The Red Cross Societv n{ ]■ 
International Connci! of Xi 
the Second Quinquennial .M 

('ounc^il of Nurse 

il)an was requested by the 
urses to rcj)resent itself at 
■^■ftiiiK of the International 

, r , - K i" Lon(l(_)n from [uK- la 

"Jnly 2,, lycK;. to .iiseuss the ,nethods oi nuri", and 

I'-itched as dcle'^ate Mis? Tni. ii • "'^"-t} ue.s- 

the I^,.,1 r XT V -lakeHa-nvara, chief nurse of 

;l=c Red Cross Nurses' Union, and n:ade her report on 

Nurs,n, under the Rc-d Cross Societv of Japan 'sie 


cHK-aK^cd in the Central Ilosnital -,s . 

r , -iiuspuai a.s assistant uisnentnr 

"f nurses and student-nurses; so her exD.TiVn. inspector 

"uiv he said to he- ver- ri f"" "'''•^'" "^'''^•^' '" ""rsing 

• • -' '"''• '"''"^' retun!i',i from h.T 

'"•.■rna.,„„al Council ,>f ,X„«, ,„|„, „;;,^^ ,/; 

A" ilK' "orld knows l„„v l,nlli:,ntlv Japan distin 
«ms,„l hersc-lf in nursin,, provcnavo' n .•* "no „d 
.m„„„on, „s well as l,y hraven- on th,- lid.l in u; v r 

!" ' "-..rrihlenoi,.!,! , Russia. Dr.Uu "s ^nn 

W-od .hat Japan's greatest ,n„„,p„shad 1, " n 

^ ''7--'"""^' "f "■•-'V and instaneed .lu- faet thu 

he had reduced the usual mortalitx- fron, pna-entlbte 

uses over eighty per eent. The „o„der[„, ea, :'! 

the Japanese nurses made it unneeessar^• for the 

nauon to apply for nursing help elscvhere,' and u'e 

'Red Cross Bulletin. No. j. i,h>u. ., -- 

276 A History of Nursing 

nursing relief i)arly ihat was called together and 
offered to the .government by Dr. Anita Newcomb 
AleGce may easily have been rather more of an em- 
barrassment than help to the heavily burdened 
naticm. I'lic report of the Japanese Red Cross So- 
ciety on the Russo-Japanese war, presented to the 
Eighth International Congress of Red Cross Socie- 
ties gives a most tacirul account of Jiis expedition, 

Mrs. Anita Xeucom!) McOee, M.D., of Washington, 
having made an offer t ( ) our government to come to Japan 
with 600 female nr; - - and in the relief of tin- sick 
and wounded sole' our government consulted the 

Red Cross Society alxn.t the mattt-r, and decided to 
accept her oft\r provided she would agree to come with 
only a few nurses. 

Although m the progress of this i)arty there wa.^ 
something that seemed more congruous with tri- 
mnphal processions than with the unassuming work 
of nursing, yet there were excellent nurses and ad- 
mirable women in its rank and fdc, and, animated by 
a sincere desire to be heli)ful, the\- did some good work, 
and friend.shii)s were formed that have had a distinct 
part in bringing the nurses of the two cotmtries closer 

Perhaps the Japanese nurse who knows America 
best 1.S Miss Choko Suwo. After the war, she came 
here with friends and took several post-graduate 
courses, one at the Woman's Hospital in New York 
under Miss Gladwin (who had been with the expedi- 
tion to Japan, and who was conspicuously successful 
in making th(> course valuable, thus attracting ex- 



ceptfonal Tvomen from all over fh^ ^.^ M^ 

though realising well the difflr-nir ^" J^'Pan. 

- .nov.>. ...^t-«-;J,-- 
-i^- mothers first Th.u , ^^ "^ "'""' teach 
■'v ..ay. so , ca,r„o l« . =.:; ^^f-' "T "" 

Miss Ni,h.i„„alc is ,,ea,ly r.vcTed in Jarnn 

arelhoseofSisa.rFi ho! 11.11 ; "' "-lU- loiiml 

"ho. writing in K,„ i^, , r'' "" •'"''^^"''"' '^••™ 

I.-PC and energy ,„ i ';.„■' t ■' J"'"'' '"" "^ 

-a<.H„s,.i,,'i!;;s,,i;L:;':;^ti:;t *:,"?/ 

u.*n„wn and .she spent iifteen ycL at w^rk ^n 

'Z CtoT ''' '"' ""^- ""■^^^- Tl- .raining "f 
ynmg L^hmese women is thnmf..^. c 

S>,.ter Etho! fralley' rcc '" k " ''''"' ^^'^• 

^a^iO} . rccouecLions, besides ineluding 


A History of Nursing 

many humourous asi)ccts of hospital life, ran to the 
social conditions of her patients as well— to the cruel 
exploitation of little liv.; .ear-old children as factory 
hards at night work, and to the hitter li^-es of the 
little slave -iris who, jjainted and dressed, had to 
earn their living as prostitutes. 

St. Luke's IIosi)ital, at Shanghai, which celebrated 
Its fortieth year of service in 1906, was one of the 
first to train jnipils. The London Mission, Peking, 
had a class studying nursing and dispensing under a 
woman physician. Dr. Saville, about 1895, and, in 
1905, this workgrev.- into a training schooffor nurses 
by the co-o])eration of the Presbyterian and Methodist 
missions with Dr. Saville for this sj^ecial purpose. 
The school is now growing and pnjsjiering. The 
training covers three years. 

One of the most attractive and interesting of mis- 
sion hospitals is the ALargaret Williamson, in Shang- 
hai, under the management of the Women's Union 
Missionary Society. It was onened in iScS6. 

The Elizabeth Bunn MemoHal Hospital at Wu- 
chang owed much of its enlarged service to the en- 
terprising sjjirit of Dr. Glanton (a woman), and a 
nurse, xMiss Susan B. Higgins, a graduate of Blocklcv, 
Philadelphia, who ciuietly made up their minds to 
move into a distant part of the city and work up a 
disi)ensary service. They had a house selected and 
ever>'thing arranged before making their intentions 
known. Others were fearful for their safety; even 
the bishop was afraid for them, but they went, and 
the success of their venture was immediate and per- 
manent. They built up a large disjiensan,' i.rarlicr, 
brought in many bed patients to the hospital, and 


ChiiH'sc Pupil Xiir r^ 

By Courli-iy nf ihf \mfriiitn J,,i,rii,il „f \ursing 




now a trainin- school has -rown up. Looking for- 
^vard to this, Aliss Emma 11. Hi^gins wrote m 1907 
with hoi)L'lul antidpatiun; 

Two have been spent in stiuhln- Chinese i.r.- 
Parinj,^ to teach the pupil nurses in their' own lan^ua^'c 
< 'ur school u-ill not be open before Christmas "^ ' 
!he Wesleyan Mission has a very ^oo,! trainin^^ school 
and their experience has been most enc<nira-in.^ Their 
r.urses arc much liked by the doctors and forei^nc-rs for 
vhom they nurse; they arc gentle, capable, and exact 
making very good private nurses. Ml thev need is 
.'^onie one to train them thoroughly. The Chinese voung 
wom.en are just beginning to appreciate the opening 
^vhich gives them independence . . . it is an intensely 
interesting field and a work that will go on long afteV 
we are dead, along with the schools of \\-es.ern nu'dicino 
which are opening. . . . we want those who can teach 
others to nurse, so that the Chinese nurses will ho 
started right, ready for the lime when thev decide to 
depend on themselves instead of on the foreigner. ' 

fn 1908, a Chinese nur.e. trained at the Wcslevan 
los[)itrJ, came as assistant superintendent to 'the 
I-di^^abeth J^unn Memorial. She was very efficient 
an.l capable of teaching the practical work In 
i.)09, another gr. iuate, Miss Chiang, was made head 
nurse. Mis^- Higgins considers that her pupils make 
K'>od nurses; tney are, she says, gentle, quick, quiet, 
and observant, and not afraid of work. 
Jn Canton, in the David (^.regg Hospital for 
Women there were in i9o<; eleven Chinese girls in 
training, while four had graduated. Thev were aU 

' I/Cttcr from Cliin:. ,1 r 



28o A History of Nursing 

capable and satisfactory. In this hospital, and per- 
haps in others, a text-book used included the trans- 
lation into Chinese of parts of Isabel Harnpton'o 
Nursing: Its Principles and Practiced 

The Central China Medical Missions Associa- 
tion has pupils under regular training in several 
places. Their grade of education is above the mere 
ability to read and write, and they are beginning to 
understand why the so-called "menial" duties are 
important, and to feel the nurse's pride in her work. 

In 1908, we find Dr. J. C. McCracken, of the 
University of Pennsylvania, in Canton organising 
a hospital. Desiring a nurse to grow up with the 
hospital and develop there a school to train native 
women. Dr. A. H. Woods described the type of nurse 
needed in words that show how far above the average 
must be leaders in foreign countries, if they would 
succeed : 

Just a commonplace nurse would not make a success 
out here at the [)rescnt juncture. So far as I know, no 
one has yet undertaken in China just the kind of work- 
that we desire the nurse to do . . . The woman to do 
this work should be mature, with proper poise, so un- 
questionably a lady that low men-patients would be 
unable to say vul,i;ar things in her presence. She must 
be not only a good nurse, but able to train others, to 
organise the work for us and keept it going. ... If, 
to other qualifications, she coukl add the virtue of 
widowhood or ccHbacy, it would k^avc us with a freer 
outlook. . . . We doctors will keep in close relationship 
with the head of tho nursing department. We will all 

■ Chinese Manual of Xursinn, compiled liy the Central China 
Branch of China Medical Missions Association, Shanghai, 1905. 



be together and so should be socially congenial Thero 
pec a ists each has his own responsibility. The nurse 

^^^::zT''^ri' ^^"^^^^ ^'^ - ^^^^^^^^ ^s 1: 

an architect employed to erect a building' Wo 
-ould not look for servile obedience, but we must If 
course, have the ordinary co-operation such arwould 
e.Mbt m a good hospital. ■ 

PoSlv tl^r"'""* "'"^ "' '"" <^Wncse poor, es- 
pcaally the women and children, and their winning 
PC mspire the mission nurses with he 

•" rtankTTr"' "*'=", "^"""araeters are eapa ,t 
r thank God I was called to China," said mL C 

nee to ten 'Th'" ^"f""' ^'^^ '""'^'''^ ™ »"*- 
thS ^ ^ I "°*' ^""^ °' ""«' ™m™ with 

her poor, bound feet, often literally rotten- the 

'i.nd made to see, and the lame to walk: If l' had 

tnenty hves they should all be spent there" And 

one martyr the nursing community has givefto 

cred at L,en Chow, one was Dr. Eleanor Chcsnut 
" ho before taking her medical course, ha.l graduated 
- the class of ,89, from the Illinois train.";; school 

r nurses .n Chicago. At the of her death 1> 

i rCho'"' ' h"^"''^' '"' ^-'^ - "ctlfdVa • 
q A? ; ™'^ " >ii'POnsary ten miles distant 

1 ettn/if " '''■'''""^■* "■°™^" '^■h- •*<= ™!r n! 
^™e .ng ,„, another to whom she was 

^• .ncdicine, and blind pupils to whom "he 

>-Sht massage. She had become'an expert scholar 


A History of Nursing 

in Chinese, and was making the translation of Isabel 
Hampton's Nursing, which her death interrupted. 
Her medical work was tremendous, and with it all 
she had collected a "family" of hel;jless de])cndents 
whom she supported. She loved the Chinese, and 
often said she would gladly give her life for China. 
In return she was dearly loved by her pupils and 

The foreign nurses in China have organised under 
the name, "The Nurses' Association of China," 
and their proceedings are reported in the Nurses' 
Department of the China Medical Journal. Their 
constitution declares one of its puq:)oses to be "to 
raise the standard of hospital training in China by the 
adoption of a uniform course of study and examina- 
tion for the Chinese"; and to this end a registration 
committee examines into the intellectual training, 
moral standard, and hospital discij)line of all hospital 
insti" I ions u'''lcr missionary, govc^' lent, or |)rivate 
control, which may desire to rcgistei under the com- 
mittee. Three members of this committee of seven 
are Chinese nurses, and the general membership 
includes all qualified Chinese nurses who hold certifi- 
cates from schools registered as being of approved 
standards. Local branches are to be fornicd as 
steadily as possible, and the association recommends 
to all hospitals that they adopt a course of study and 
examination approved by the Medical Missionary 
Association of China and Corea. 

Representations were made in 1908 to the Central 
China Medical Association Board, emphasising tlic 

■ B ulktin , IlHnoi ? Tra ininR School A lumncr A ssocintinn , November, 
1905. Article, "Eleanor Chesnut, M.D.," by Katharine De Witt. 



tanclard oi m Chma. and this board agreed 
^o onduct penodical examinations and give ^ 

ot certificates thus gamed .vas made to nurses from 
different parts of the Yangtse Valley ' 

reacal and practical instniction, and now since 
centra exammations are in force, membership' inThe association means that Chinese nurses nav! 
taken thi. examination. Of this successful piece 
of constructive work the leaders wrote: 

The venture has been a great success, and already 

here IS the spirit of advance manifested. The nursed 

are showing more zest in their studies, and he feeW 

^tmonpst tl.o 1 f . ^ ^'^ '' '""^^ particularlv so 


1 he leaders in Chinese nursing organisation ; 
M^- Caronne Aladdock Hart, 6^.t president of t 

-rua/, January, ign. 


A History of Xursin'r 

Nurses' Association; Miss Mary C. Ogden, of Anking, 
her successor in office; Miss Nora Booth, of Hankow; 
Miss Maud T. Henderson, from the Boston City 
Hospital, at work in Shanghai in the Refuge for 
Chinese Slave Children, whose terrible stories had 
originally led her from America to China; Sister Ethel 
Halley, Miss .Margaret Murdoch, of Hwaiyuan, and 
many others whose share in upbuilding cannot yet 
be fitly heralded. On the registration committee of 
lyii stands Mrs. Ts'en, the first Chinese nurse to 
hold such office. 

Surpassing all other efforts in interest are those 
projects for medical and nursing schools in con- 
nection with hospital work which have been planned 
out and set on foot as national undertakings by 
the Chinese government itself. In this work, Dr. 
Yamei Kin, a woman, whose medical education 
was obtained in the United States, stands prom- 
inently forward, but, because of the immense revolu- 
tionary movement so recently at an acute stage, the 
truimjjhant success of constitutional principles, the 
(partial at least,) enfrancliisement of Chinese women, 
and the resultant intense activity and absorption in 
home aflairs, the full story of this large plan, which 
had been promised by f:)r. Kin, m.ust be postponed 
for some laier historian. In the Tientsin Hospital, 
where Dr. Kin directs the Woman's Medical De- 
partment of the Chinese Government in North China, 
there is already a flourishing training school of forty- 
odd pupils, whose nursing superintendent is Miss 
Chung, trained at Guy's, in London. ' Early in igi i, 
Dr. Kin brought to the Unites States a young Chinese 
• See Chinese Students' Monthly fur Mar. h, i<,i i, p 479. 



woman, who, after a college courso i-; tnhr., ■ ^ 
tht> Tnhnc T-r^ 1 ■ , "-""rse, IS to be trained at 

he Johns Hophns .school for nt>rses and return to 
U>na to contmue the development of the service 
entrusted to Dr. Km. ^Ve therefore leavrcWna 
■'H the threshold of momentous changes 

Tl.™^';?'' '°°' '^^ """'"S P-^-- to show. 
. ".^mes of nursmg pioneers who blazed a nath 
here include that of -Vnm P t u ^ 

,.n,i,.H of. ^ • J^'-'obson, whose life 

-ided after a year and a half of service. She was a 

the .Severance Ho.spital oiJonr.f1 if- ^^u'O^^nen 
'raining school for CoJn ^n^.^ WtTtZ™'"' 
years' course, in ,,,06, Miss AWa « t IM T 

■Von. the Ann Arbor University ^.i, ,L s^u' 
..; charge. fu„ of enthusiasm and fai h n the fute 
u her „orI<. -The Corcan women ha>o pH 

rote. Ji^ssKimhev^AHalomyandPhvsioloav \li.^ 
Maxwell's and Miss Pope's rext-^ookouT^iJ^" 
and parts of Mrs. Robb's books have been tr.Xd 

nu ses Ts ta kid T ' ,""""^ ^"'"^^^' ^- ^-^^n 
The wo t 'fc^^ ^^ ^' .'^^'^ "'^'^t professional need, 
he work at Severance is under the American Prcs 
hs tcnan Roard of Missions. 

ft would takf a r'o'"m*» to «^ j i 

-".-me to record adequately th* 


A History of Nursing 

growth of nursing in far ijlaccs; In Amtab, Tur- 
key -in-Asia, the Memorial Hospital named for Dr. 
Smith opened a regular training elass for native 
women in 1909-10, with Miss xMiee Bewcr, Phila- 
delphia Ilosi^ital, in charge, and Aliss Charlotte F. 
Grant, of the Boston City, in the operating room. 
Four pupils were enrolled, and a course of study 
arranged from Miss Bewer's note-books and transla- 
tions from Hampton's Nursing and Nursing Ethics. 
The head nurse wrote: "On the whole, the work of 
the nurses has been most .satisfactory and encourag- 
ing. Our hope for the future is to have pro])erly 
educated girls come to take the course, but we must 
first have a proper place to hc-i'^e them, and etiuip- 
ment to make coming here attractive."' 

In 1908, the missionary nurses working in Turkey 
were voted in as full members of the first conference 
of the Medical Missions Association of that countrv, 
and Miss North, stationed in Ccsarea, reported excel- 
lent work in the training of native women. An asso- 
ciation of nurses in Turkey was then first suggested. 
In vSyria, a wide influence has been exerted by 
Miss i:(lla Wortabet, an English nurse, who wrote 
a nursing text-book in Syrian. The training school 
of the Protestant College, at Beirut, graduated its 
pioneer class of three in 1908, with thirteen pupils 
entered and a waiting list of as many more. The head 
nurse, Miss Jane E. V'an Zandt, of the New \'ork 
Fost-Graduate, wrote that the educational standard 
for nurses was very good and tlie outlook most 
hopeful. ' 

' Bullftin, Ci-nlrn! Turkey Cnllfgi; December, 1910. 
'A. J. .v., January, 1909, p. ^74. 

A Cirimp ijf Ciili.tii Nm•sl•^ 



In Greece. English nurses have shown a model 
of hospital work, and Greek maidens have erossed 
he seas for training to carry back for the sendee of 
hc.r country. Th. first so to come to An.erica was 
vleomke K onare. in h;oo. to the Massachusetts 
C-enera , and m 1904 came three Greek girls under 
the protection of ono of the royal lamih-. Two fol- 
-^ved .vl.,s klonare to her alma ma'ter and the 
third went to the Baptist Hospital in Boston 
_ in iersia, amidst all sorts of difficulties, Mi.s R 
O. Mclvim. of the Toronto General, worked lovally 
^rom 1903. and so in even.- corner of the earth tiie 
nurse s cap and pin may be found. 



Collaborators: M. Eug6nik Hibbakd, Cuba; xMabeu 
AIcCalmont, The Philippines. 

Cuba.— At the conclusion of the war with Spain in 
l9o«, the Sisters of the rehgious nursing orders in 
Cuba were withdrawn by their Motherhouses, and 
the officers of the United States army faced the 
difficulty of equipi)ing the hospitals with an efficient 
nursing stall. 

One of the p;roatest problems presented to the govern- 
ment of the United States at the beginning of the occupa- 
tion of ilK^ Island of Cuba by the American forces was 
how to deal with the appalling condition of her hospitals. 
A visit to some of these places would remind one of the 
Dark Ages. They were dens of immorality and unclean- 
lincss in every form. Their unsanitary condition was 
responsible for much of the sickness in the cities and sur- 
rounding count ry. No precautions were taken to prevent 
the spread of disease. In many instances, where expens- 
ive apparatus for the disinfection of elothing had been 
provided, il had never been used. Din \- waWv from tin- 
baths and laundries was often disposed of by being turned 
mlo the street. In some places, clothes were washed in 
the rivers without previous disinfection, to breed disease 




wherever the river water 

n-er water wa. used, Those employed in 

Nu ^r V name rufcrmero, attendant on the sick, was a 
term of dej^^adation. ' 

So wrote one of the well-known and active members 
nf he nursm,^ profession in the United States who 
had gone to Cuba in the army ser^'ice. 

The nursin. service of the Sisters in the hospitals had 
been of a reh^ous ra.her than a professional nature 
hough under the supervision of the medical director 
ney were directly influenced by the Church, and owinJ 
to thcr vows were unable to perform eflectnelv tht 
dunes of nursmg. In domestic management their\vork 
uas perfectly done. Evidence sufficient to convince the 
most could be found in the arrangement of 
Wrooms, closets^ storerooms, pharmacies, and kitch- 
ens, m the care of the hnen used in the chapels, and the 

mhers _ The pdlow and sheet shams which <lecorated 
he patients' beds on .aints' days were beautifully c^rJ. 
'roidered and lace trimmed. No doubt great pride was 
taken v a,s department, but in actual nursing the 
S.s ers duties consisted principally in .listributmg wine 
and soup to the very sick ones, and praying bcs,de the 

By the voluntary withdrawal of the Sisters and their 

.turn to Spam [s.aid Mrs. Q,:intard], the field was left 

cl^'ar for the mtroduction of American >nethods, and the 

/.''Zr'"/"/-" ^'"'^■''•';'?r ^''''^ Q'''"^-''. -' Tmnsaoions, Third 
lri,,rnaHo j/ tangrcs of Nurses, Buffalo, igoi 

'»S. ."^, 1904. ,,. 041. 

Vol. IV. — 10 

2 go 

A History of Nursing 

men to whom this work was cntnistod, recoj^mising the 
htTcuIcan nature of the task bcfon> them hi reorganising 
the liospitals, and their helplessness to accom- 
plish it single-handed, turned to the nursing profession 
for assistance, and met with a hearty response. Good 
women answered the call and went to work with a will, 
working early and late to co-operate in every way with 
the heads of the departments,' 

Mrs. Ouintard herself was one of the first to turn 
from the nnlitary nursing to rcconstnietive work. 
In the hospitals' crisis, Major L. j. (ireble, head of 
the Department of Charities and Sanitation, secured 
her services and those of Miss Sarah S. Henry, and 
appointed them as special inspectors of hospitals to 
assist in tlie establishment of training schools for 
nurses in Cuba. They had both, at diflerent times, 
previously held the imj^ortant position of superin- 
tendent of the Connecticut training school, and Mrs. 
Quintard was one of its graduates. Before the war, 
she had been in charge of the training school of St. 
Luke's Hospital. Xcw "S'ork. As s))ccial inspectors, 
these two women laid the foundations of Cu./an 
training-school organisation, and during 1899 and 
1900 many appointments for the new work were 
made among the arrny nurses or those coming direct 
from the United States for the purpose. 

Tt was in a sense [said Miss Hibbard], much easier to 
rebuild on a comparatively vacant site, than it would 
have been to uproot and reorganise at the same time. 
So, regardless (if the conditions that may have previously 

* ** Nursitm in Culj-i:'* 



The vl ' " '■""'" '^^^'''J- of Ihcir „„■„ 

;-;;,:; =pi;:r;-.i- -: 
uit, snrulJb and /lowers ijomlinr tr^ <t, 
r i^^, , ^''^ P<-cuiiar to [hv couiUrv AH 

•• dcpartmems .•,„ «„ cqu,p„ccl .„d, at U 

; "K „ ,h. m.luary occupation in iSyS-.j,;, i, „-,s 

An.enean ,,a„cnts. „. „,edical director wa Dr 

tr;, ' "■""°'' "*° ""'' ■'«■" deported h . ,c 
•■l>a.i.^h Rovcrnment to the west coast of Africa and 
»d r^, „ ,„ Cuba after several years abcnc^ 
k read,!;, co-operated wuh General Ludlow, General 
irooke, and Major Furhush, all of wh„n, were s 
«-,a ly ,ntcreste<l and in.,tr.,„,en,al in cstal, i hing 
;' '"''.'' °''''" "f "«"SS, and in August, ,s.„, ihe (W 
.rannns school was opened in this h„s L- w ih 
^^. en, under the d.rection of Alis Man- A 
•:".u;l,, ,a graduate of Hellcvue, who had L n 
"*.nK n, the annj- ,.ervi, e and uhose contract 2^ 


'itT new po.sition. Mi,. 


292 A History of Nursing 

O'Donncll thus holds the proud position of premiei 
among American training-school heads in Cuba.' 

An earlier attempt had been made which must 
not be overlooked. In January-, 1899, Dr. Raimundo 
Alenocal had opened a school for nurses in the Havana 
Sanitarium. It had twenty-two pupils, who were 
placed in the charge and under the instruction of Dr. 
Vidal Sotolongo. This school, however, only existed 
for five months, the sanitarium being closed'in May. 
Dr. Alenocal remained interested and was actively 
helpful in the work of e^ . Jishing the permanent 

The public charities of Cuba were thoroughly 
reorganised in the early part of 1900, and iMajor E. 
St. John Greble became the first superintendent of 
the Department of Charities. It was placed under 
the general supervision of the Department of State 
and Government, and schools for nurses were opened 
m connection with the public hospitals in the follow- 
ing order: In 19W, in March, Hospital Civil Cien- 
fuegos, with Miss Jeanette Byers, of the Woman's 
Hospital m Philadelphia, as superintendent- in 
September, Hospital No. One, Havana, with Aliss 
Gertrude \V. Moore, of Bellevue, who, three months 
later, was transferred to a fresh field, being replaced 
by Miss Holmes; in October, Hospital Santa Isabel 
Matanzas, with Aliss Hibbard; in November, Hos- 
pital Genen-.l, Puerto Principe, with Miss Mitchell, 
of St. Luke's, New York; in the same month. Hospital 
General, Remcdios, with Miss Samson, from Pellc- 

' During },cr st.iy in C-uba. Miss O'Donncll translated Mrs. Robb's 
Text-book into Spanish, and wrote notes of her own in the same 



f premier 
"uba. ' 
ich must 
■ Havana 
.ho were 
3n of Dr. 
y existed 

in May. 


'lajor E. 
ident of 
d under 
of State 
' ojjened 
? follow- 
il, Cien- 
ent; in 
th Aliss 

T, HOS- 

1 Pellc- 



and in Januarj-. igor, Plospital Civil I 
de Cuba, wi, h Aliss Aioore, who had been transferred 
here fron. Havana. Eaeh of these women had with 
'HT a Staff ot tramed nurses, representing many of 
tiie ^chools scattered over the United States ' 

Seldom, if ever, has so complete a transformation 
.akcn place m hospitals m so short a time, and in such 
-holesa e fashion. On the retirement of Ala o, 
Greble Iron, the position of superintendent of the 
Department of Charities, Major J. R. Kean received 
the appomtment. and the subsequent success of the 
schools was due largely to his personal interest and 

tTLTn"";"" 1 ''' ''''''' -^-— ^s at this 
cntica penod ol the schools' existence. Like all 
-en who have been successful in furthering the es- 
tabhshment and maintenance of good nursing he 
-as .vilhng not only to be advised by nurses, but to 
accord them spheres of real respon.sibility, and to 
.reat then, as equals and co-workers. The results 
.n Cuba have been so brilliant and so sound a s ;x 1 
hat Major Kean and the won.en with whom he 
worked m harmony deserve a very special distmction 
among thejr fellows. No country has had a more 
carefully p anned and wise design to developTnd 
conserve a h:gh standard of nursmg education under 
^he guardumslup of the state, a standard which rt 
nas steadily upheld. In July, iqor, soon after tak n! 
office. Major Kean issued an order, reading as fl:;:^ 

H-™a Cubf "rT'^I- ^^^•'^'•^'-"t of Charities, 
vtl r r • '^"^-' '''• ''^"'- ^y authoritv of the 
i''?^'.^^?-^,'^":' =^ ^--^' -i" he convened to ,.ect in 
— •---■^^- 01 mo oupc-nntcndent of Chanties. Havana. 

294 A History of Nursfno- 

Cuba, at twelve o'clock, July ... i,or. or as soon there- 
after as practicable, to draw up a s^stc. of rc^^ulatio^. 
for the trannn, schools for nurses in Cuba. Th .nl, 
also fix the course and duration of instruction the re 
qu.remcnts tor admission, the standard to be reeled 

r IZ rr'-""' T' "'-^'^'^ ---"-ndations' h 
regard to salaries and allowances. The board will al o 

recommend a suitable manual for use in the nurses- 
schools, and in .he hospitals under state control The 
board w,ll be composed as follows- 
of °rh ^^T"^ 2"^^'''' ^'^^-P^-'-d^t of the Central Board 

Director ;7\f""r=°^- ^""^'^^"^ ^'-^-^^ ^^^^'clico- 
U rector oMercedes Hospital, Havana; Dr. Enrique 

tie • Aliss M^T'^'"'' 'r:T'''' ^^^'P-tment of Chari- 
^Nu':. M iS:^^ '''''-'' ^"P-tendent. School 

Staffs' Ari/s''- ""T '.^'''^''' ^"^ ^"^^-^" United 
btates Armv, Superintendent Department of Charities. 

The meetings, several in number, were -ell nt 

lZ:'i "'l'" ''' ^'"^ °^' '''''''''' ''^-' - plan of" 
general regulations was submitted for the approba- 
tion of the eentral board of charities. In October 
K ^^•as somewhat enlarged, made more eomprehensive 
modified m T,articulars, and again stibn.itted On 
January 3, r<>'>3, the plan was approved in entirety 
by the military governor, General Wood. 

The object of these schools shall be. first to further 
and man taming a universal standard for instruction 
and providing students with the proper means of educ ' 
tion in the practical care of the sick: second, to secure or 
the studenc upon graduation a degree or title, which w^l 


>on there- 
They v.ill 
T. the re- 
ons with 
\\ill also 
e nurses' 
•ol. The 

■al Board 


f Cliari- 
:, School 



veil at- 

plan of 




i. On 


edu ca- 
ll re for 
ch will 



employment; third, to 

nu.nbcr of , rad d ' " "" ''y"""""-'"'- •™J a proper 

for the two women on ^,.', "\°f '^'"™'--='n nurses, 

fe u-crHn, P.^n^.n^ ^tit^ r::!:^^^-/-™" 
orKan.sation for Cuba, ''■tir cx,K-rtl„ T7^^ 
-ci.iy deferred to by the Cub "^.'^^r'^ 
Ivean wrote later: "The Cuban LZrZJ'T 
eduealion and the praetice of tl,„ f 
nursin,. was drawn up under L' "'°^'."°" "^ 
- in the ™ain Miss ffibblrs handi^""""',';"' 

"mI rH-bb "7 ''''"''' ^^' sat'Xetory ,aw •• ^ 
-\Jisb Hi bbard wrote: 

The aim and fixed intention of fi.^ • . 
Panisin, these schools wa o put th^' """'"' ^" "" 
highest attainable plane .itif. tic "e:,"? " -^i'^ 
^•ork in other countnV. . c\r • "^ ''^ ''"^-''^i' 

<^^-fining emphatically the j^^ i il ,.7 ''"^"^^• 
-untry until recent v i^'no" ' ^' """^^ '" ^ 

' niclii.led in Governor's report, 

hstiblishment of School 

s for .V 

rt Jan 

'uary ,^, 1902, p. 9S9. 

in (^ 

■ ur„ng, ^^optember, 1902, p. 9,^9, 


A History of Nursing- 

These schools arc all in a healthy, flourishing condition. 
jWTote Mrs. Quintar.l in 1901J; they have been estab- 
Iished on a good, fimi foundation, and if the present 
status can be maintained, and good American nurses 
kept at tlie head until their own women have sufficiert 
experience, after their training, to occupy positions as 
supenntendents and head nurses, there is no reason 
why Cuba should not. in a few years' time, be able to 
boast 01 a hue nursing service in her hosjiitals, as well 
as of a thoroughly trained corps of women to meet the 
demands of jirivate j)atients. 

This forecast has been realised. Under the- p o- 
visions so wisely made, and as a result of tlie good 
standing given to the nurse, the schools were q.iiekly 
filled with >-oung Cuban women of refinement, whose 
families ^^,,uld never before have dreamed of con- 
sidenng f,.i a ni,,nient letting their daughters go into 
the wards ,>f pnl>Iic hospitals to perform duties 
which. It had always been believed, no one but a 
religious Sister could perform without loss of woman- 

The regulations, which are wrll worth repeating 
in full, shall Ik- summarised briefiy. The schools 
were to bo state institutions, attached to hos])itaIs 
for mutual l)enefit. but under the direct control of the 
Department of Charities. Thev might be est.iblished 
m all cities of Cuba where there were public hospitals 
01 over onr hundred beds, after previous approval 
by the department and in.scription in the .school of 
medicine at Havana. Not less than twentv students 
sliould be taken into a school. A committee, of 
which one membt-r must be a graduate nurse havin- 
hel.J superintendent's post, was ai,pointed to deal 



trained as* an.s „;'?""'*■"' °' ""»« -ith 

was to have the T)rf>f-,>,.f,- r, " "-^^^<^^"fy. ^vhich 
ujL j)rotcrtion of the si'it.. tk 

lor nirfil dutv 1>^, . ""'■""" '"''Ivclirairs 

Mudents, e cept ' "\ f, """'"'^ ™^ '°"'''''''^" <-^ 

arvico wore t., hcZTt ' "■' '■"''"■^'J '°' ^^"'-■l' 

'"■<t schools. Thus r„l oT , ,^ '■ "' "^' '" ""=,ion for nui^ ""■ ""^' "— P"'-'^ 

ffad it not liccn for th,- 1 

ominalions. I,„t havn hH 7 , '■"" "•""'rsity cx- 
f™ schools rcco,„is::d 7, , "x .,:'","",'" ■•'" ""' 

b^' used ex'-™;;-;:, a'!:LZ'. ::/::.'"- "'-•"'">■ -' 

: -- •i^Obniscu schools. 


A History of Xursinq- 

nor may institutions apply this title to other wot -en 
i he j^raduate nurs. is entitled to the protection ■ the 
courts. The non-.jraduates are not recognised. 

There is a roll of honour of the men in power who 
have con.sistenily kept the standard of nursing to 
Its original level: they are Dr. Emiliano Xmicz di- 
rector ot the Mercedes Hospital; Dr. ]. M. Pla second 
dire .tor ot chanties and hospitals; Dr. Carlos Finlay 
and D:. Lrnilio Martinez, members of the Centr,! 
Hoard of Chanties; and Dr. M. Delfm. first director 
or ehanties and hosj^itals. With vigilant care and 
protessional pnde, they have kept close watch to 
prevent any signs of deterioration. 

The American nurses gave admirable service ir, 
the reformation of the Cuban hosi)itaIs. It wa. their 
first piece ot work on a large scale outside their own 
country, and many made brilliant records The 
wnole number u!:o took part in the achievement 
reached close to seventy-five. On ;he :;ist of De- 
cember. ,<jo,. the ii ts in the omcial reports showed 
thirty-seven American nurses s-,afi:ng the hosjutals 
as head nurses or superintendents of school.s. Many 
of them a.-c nnu- members ,,f the order of Spanish- 
Amcncan War Xurses. by virtue of selection ap- 
;Kuntment. and duty performed as contract nurses 
in the L-nite.1 States .Armv, i,revious to December 

''!'!/ , •'^■''^"K ^^^-^^ ^^->' ^<^^^ Abel. Minnie Cooke.' 
Wilhelmina C.icsman, Frances McCurdv. Mariette 

Meech. Anna ODonnrll, Mary O-Dnnncll OHve I'en- 
dill, (lenrvieve Ru.s.sell, Arina Turner, Tweed 
(now ,Iead). Hannah Waddrll. Marv McCloud 
M. I.ugenic Hibbard. and Annie OT.nen The last 



ta^'ious hospital 


Animas con- 

nearly. i,„ ,',,,, ' '' >'"'"-'"" "'•■" ^ho has hdd for 

lyn. Grace of j3olroit r 'X'' -^''">- s of Brook- 

•he PennsylvanL M^ 'n'-^' °' ■^™- "*-^ -d 

Chicago. SL Luke's o X " y '7 , ^f"''' 

of young Cuban uouK^n^VrinVll """"'' """'"» 
the AuK.riean.s Ix-an to tWnt ? """"-" ™"'"' 
A.nerican oeeanation « a *■"""» ''"'""^- Th<= 

"'hdak were /ear; : ';,;;;'■■' 7' ^'""^^ «'••"- 
-iJ. -ere an„„g uLe vtat. n ;""';"'■' " 

''•■•y '" 'he , as, even t,,„:; 'a, ';";.'""' '" 
■■-landards 01 order m.l ,.l r , • "'""" "K"i 

I'- resented l' ,;':.;:' ,^ had heen ntore or 

'■-rdton,,u,er-'(- ,.;".:■ " '"'""'' "'""■'""« 

I TOmot,o,il,n,e for 11,,. ,,,„„,. Cnl, 

'''■'"'': "'-"--■f'he,n\„r/,.'^^^^^^^^ 

'" "-'iiniiur schools 'n,„r . I "^^'J ^t tjic heads 

t-«''^hv:Jt,,e ttatnrr"-'^-^''™"---' 

"hat she hel.l for six ve-,rs "1^'\^'"<;["-':"^. :< I-st 
■' <he Mercedes i„ ■\'«'".-. (."evara «ent 

i^pita, ^:X: kH',, ;;:'::; '^-^r •" 

Victoria nni t.. n ^'^'"'Tdo, to rienfue.i'os; 


A History of Xursing 

Preventive social work now received the attention 
of the Cuban patriots and war heiocs, and Miss 
Hil)bard was selected to organise a corps of visiting 
sanitary nurses which should constitute a special 
service under the Department of Health. The 
members of this corps included three of the retiring 
American superintendents, Aliss AI. A. O'Donnell, 
who had a record of nine and a half years' continuous 
service; Miss AI. Jcanette Byers, who had served 
six years as a superintendent and had been in Cuba 
for eight or nine years in all; Miss Mary E. Pearson, 
who had a similar record, and Cuban nurses, 
Senoritas Adelada Jimancz, Rosa Luisa Ortiz, and 
Emma Deulofeu. 

Miss Ilibbard's nursing career merits more than 
passing mention. Half Canadian and half American, 
she was trained in the historic school of wSt. Catha- 
nne's, and had made a reputation in hosjntal and 
training-school administration when the war with 
Si)ain broke out. Her vacation was spent in the 
tyijhoid camps, and an eventful war service followed. 
This was concluded by her voyage to South Africa 
as Sui)erintei]ding Sister in charge of the hospital 
sliip Maine. She was called to Cuba in Kjoo, and 
after two years there, was appointed by the Isthmian 
Canal Commission as chief nurse in the Aneon Hos- 
pital, Panama. Of the two and a half years spent 
there, she said; "There was, I realised, a stupendous 
piece of work before us, and so it i)roved to be: most 
diOicult at the time; now the inost sati-sfactory piece 
of work I have done." (Two Bellevue 
nurses, Miss Markh tm and Miss McGowan, ac- 
companied iier to the isthmus.) Recalled to Cuba 

^"^^ 301 

of Cuban nursing ' ^ """'' "^'^ S™"''') 

Alatias Y. Fordone 0";'™ 1' l*""""™'' °'- 
tionist, and Mtruist »^l%, '"™''"' '■'^™'«- 

promotions to be the fir.f c:«^ , 7.^ '"^^^-^ ^^ 


Among the many innovations of the new depart 
m.^nt was an active anti-tuberculosis <■ . -^ 

unrated by Dr Duoue f. r Z '''' ^-^-'paiffn. inau- 

J I i. i^uque, tor the success of u-hir^,, +u 
liospita isation of t-hn f, i , wmcii the 

^x-g of first impo":r;r"^ ^^^ ^^^^^^^^ -^^ 

^i'sease. A corps o'f mrdLal n pt t^ ^^^^ ^'^ 

'"K' staflf. was organised to investigate th. 1 ""'" 

'i>Uons of tuberculous patient and I r n"^ '""■ 
''opcfulofrdievmgthe Leh^les^. , ^.^"^"^ ^^s 

..Mi.hed Th !-:■!: ■,';,^-'- -s a,» ... 
»I-cia, attention fro™ Dr „ , "^ C'Th """■ l" 

■•— w... io promote educational progress. 


A History of Nursing 

the creation of post-graduate courses on special 
subjects was undertaken. 

How striking the contrast between the old and the 
new regime, and how remarkable the results gained 
in one decade of teaching young and impressional)le 
women the i)ossibilities of jniblic duty and social 
usefulness under freedom, was brilliantly demcju- 
strated when two Cuban nurses appeared at the 
London Congress in 1909, to report on their country. 
This hapijy event was brought about b}- the kind of- 
fices of Miss Hibbard, and the liberal attitude of Dr. 
Duque toward the nurses and their work. It was 
his desire to have the Cuban delegates sent officially 
by the government, but, the non-official nature of 
the congress making this impossible, they were sent 
as delegates from the Department of Health and 
Charities. The nurses chosen were Miss Marguerite 
Nunez and Miss Alercedes Monteagudo. With them 
came Miss Hibbard. They brought the kindest 
letters from Dr. Duque, whose interest in high 
standards of education, and dc .ire that the young 
nurses should enter the international group, were 
fully appreciated. Miss Nunez brought with her a 
pai^er describing the schools for nurses, as here im- 
perfectly outlined, and added the plan for extending 
modern methods to the care of the insane, .saying: 

( Jur nurses receive experience in all branches of nursing. 
In the insane asylum, in our .\ational Manicocomium, 
there exists a school for special nurses; hut the specialty 
does not consist in more advanced studies, hut in ch'dica- 
tion to that branch of medicine, without acquiring, how- 
ever, otiier knowledge than that necessary to take care 

A I.ri.iler in ( ubaii \i 



Ml [saai- 

Fr)riiicTlv Siiiitriiiiiiiilrtit iif the Illiii.,1, Training 

SiliM"! ,itw! then IiitiTstatc Si-niarv; 
lliii'l. Aniiv Nur^u ('r'ri»> 


of the poor lunatic. This 




present the Secretarv of Ilcahh -mrl ru ■<-■ ■ . 
the school a more sdonfF.T\ ^''^"^'^^ ^^ ^"^ing 

He now intend thaonK T ^""'^''"^ -^'anisation. 
special cour e and s"a I T " "T" '^'^^^ ^^^'^^ ^^'^ 
them to care i^l^fc^^'Z^^,^:^!' '"^'^^'^"^ 
they pass the examina "ons 7u tn """' ''^' 
situated some nine miles fronn -^^^"'^ocomium is 

and the asylun. ha'ac ommod < ""'; '" " '""''^ '''-''' 
^vhich is an evil } '''''°"'^"^°^^^^''«" ^r 2.S00 patients, 
be su rcirtlv e i'T'h ^^ -fortunate insane canno 
point o? view ""'"'' ^'■^^""^^^>- ^^"^ ^he medical 

students, and eighteen voun. r "'" ^^"^'-.^raduate 

quire the knowledgr^ffident T.""'' "^'^ "^" ''^^- 
if I miv Ko r. ^f hcient for the mechanical care 

,/ may be permitted the expression nf ft • 
After next August it will ho ^^ 'T^''"'"' ^^ the insane, 
of the UnitedTtat who '"n'^^^^ °^ ^^'- ^^^^^^er. 
directress of the scho;i -n^s ,1^^:^"' T ''' 
and from whom I expect the he u '" "^^^"^ 

fitness, her energetic Inracto--', T ' '" "'" "^" ^^^'• 
for won. The^gov^^n^n'of clt^r\T'^^ d"'^ 

P-fesso;;f C-^ollr^^^- --'-- appoint them 
'^^yself. entertain very .reat vemr.r""";"'"' "' '""" "' 

my professional '•^•-'- - - '• "" ''^'-'mnin- „f 


'H'bted for what little I 

To ?->?5h!,. 
:'ni, and if I ha 

'ill 1 am Hi- 

ve not achi(\-ed 


A History o' Nursing 

the fault is not hers, but my own insufficiency. 
I do not claim that the schools for nurses in Cuba are 
or-anised in a perfect manner. There are certain short- 
comings which the Director of Charities, Dr. J. M. Pla, 
intends to correct, in order that the schools may be com- 
plete, and with respect to these reforms much depends 
on my observations and studies here. 

As mentioned by Miss Nunez, two English nurses, 
specially trained in the care of the insane, were in- 
vited to Cuba, but witli the regretted resignation of 
Dr. Duque (for pohtical reasons), in October, 1909, 
the arrangement of work at iMazorra had gone' back- 
ward. His successor returned to the old methods, 
and the English nurses, whose work had been ex- 
cellent, went home. 

The state hospitals of Cuba now employ ninety 
odd nurses in permanent positions. They are dis- 
tributed among the institutions receiving state ap- 
propriations, of which there are twenty-three aside 
from the training schools, the latter being classed by 
themselves. The republic yearly sets aside an appro- 
priation sufficient to educate one hundred and eighty 
probationers, and, since 1902, one hundred and 
ninety-six nurses have received the state diploma. 
It seems probable that Cuba will not be overstocked 
with nurses; neariy twenty per cent, marry, and 
marry well. Signorita Marie Sieghe became the 
wife of Dr. Finlay, son of Dr. Carlos K. Finlav, 
who was the first to suggest the possibilitv of the 
transxmission of yellow fever by mosquitoes, and 
who received for this service the decoration of the 
Legion of Honour from France. 



If we should now in Tnir, ^ n 1 ^ 

r.f n u ^^vv, in 1910, follow up the first ^nt 

' or I , If "T''""' =^"''^' ■■" a ™*"=.l dt 
.'-ten Aletter, describing this, said: 

■•'^. o Clock, an hour after the aecMont v v c 
-.aniscd at once. The Pre.VleJt so t^e Set '.1"^ 

train, leavin.r at 7,0 t" '^" ^'^' "^^^"^ «" a special 

(-■tiUa xNunez and Scnorita \rTrf;,-,-, fu 
"f Mercedes TTn.,,;, i ^ -^lartnia, the supenntendent 
lercedcs f lospital. are domg excellent wcrl: and havP 
t'ec-n on duty since the accident happened Th i n 
-;t hn.e the Cuban nurses have been XpencI^ p^n o' 

.11 !;• "^^ Z.!^^"'" f^ ^^'- '^ P^'^t^^^ of their work, and 
-:•-...;;. oi me .p.nt ihey iiave shown. The nurses 

VOL. IV.— 20 


A History of Nursing 

wcnl by j,'overnmeiit order, as they eould be moljiliscd 
niueh more (juiekly than under tlie Red Cro-;.;. ■ 

The C}ovemor of Pinar del Rio afterwards sent a 
silver commemorative m.edal to each of the nurses. 

The first Cuban pioneer to other eountries has also 
gone fortli in the person of Senorita Maria Luisa 
A.c;uirre, who has replied to a call from Panama to 
become assistant superintendent in Santo Tnmas 
Hospital. Dazzling visions of future opportunities 
opening before th- nurse;; of Cuba in transforming 
the hosjjital situation throughout the whole of the 
S'-uth A-ncrican continent rise before the eves, as 
one contemijiates the annual group of alumnic sent 
forth from the Cuban hospitals. By their birth and 
language, their knowledge of the customs and habits 
of tropical countries, their experience of what sanita- 
tion has done in their own land, and their trium])hant 
success in demonstrating the ability of the daughters 
of the south to take command, they are clearly the 
ones in line for this oncoming immense piece of up- 
building. There can be no doubt that, in a few^ years 
more ^'^Ivance g:i .rds of Cuban nursing battalions 
will begin penetrating these as yet non-nursed coun- 
tries, carrying into them a practical application of the 
principles of prevention of needless dioe and 
misery. And may it not be possible thai the Spanisli 
nursing field is also waiting for the Cuban nurses? 

The National Association of Nurses of the Republic 
of Cuba was estalilishcd March 29, 1909, and within 
one year numbered three hundred members. Its 
first honorary member was Senora America Arias de 

'Lut!(_r iT'jin Miss Hibhanl. Mav 2^. loio. 

Porto Rico 



^.ome.. „.„o of the President of the Republic 
J, y d,„..ted their .ssociat.o,, w,„ ,,e thc'n « 
>o«<rlul .,r«an lh:,t the nurses ean have for n,ain. 
tanung the.r professional and ethieal standards 

Porto Rico -Porto Rieo has also a record of good 
u ork done. There are two excellent training schools 
" thetsland one in the Presbyterian Hospita wl iel 
" ""J" ■™='»-™ ™=^l'icos, and the large- ail-^r sx-h , 
-nneeted with the Wunie.pal Hospftal. T laUe 
jvas founded and placed on a finn b'asis by L s w 
-. Pope, from the New York Presbyterian. She Ind 
j;re, as assistant, a young Porto Rican. Se ori a 
lar Cabrera, who had been trained in Ba!tin,o e 

When M,ss Pope returned to the United States 

Cab-ra «-as made superinumdcnt of the scteol' 

"d amtdst her other work translated into S, nn" h 

H. text-book which had been written by tMi s M "x 

ell and Pope together, and which spoke ,l« 

m JTc, '" "f""'^' """"'-'• '^'- Cabrer,. a < 

.l,^s. .She fecks deeply grat.fied with their ea n t- 
Hss and capab.hty. and is hopeful for the future of 
"iir.-ing ,n her native land. 

.:-vhi,e earned on .almost; ' t'/erit::- 
into t^Mift •:rf,,','.;! °?™>'^;'?"--^.'-''y adop,,„,, 

^"^'^'"ipinos tlicmselvep 

■ i ui tii 


A History of Nursing 

and its wonderfully rapid development have probably 
not been surpassed elsewhere. 

There were about one hundred and "wenty-fivc, 
in all, jf American nurses who, in the amiy service or 
under the Red Cross, came to the is'i.;nds during or 
soon after tlie war with Spain. Interesting as their 
story would be, their work was not esnecially signifi- 
cant in relation to the development of the nursing 
prfifession, for, as soon as their immediate duty was 
fulfilled, most of them left the islands. Some fevv- 
Red Cross nurses joined the army service, but with 
the adoption of civil government the army nurse corps 
has been gradually reduced. The work of the army 
and navy nurse will always be localised ar ^ devoted 
practically lo Americans; the real nurs. ,^ of the 
PhiHp.)ine Islands -the work that will reach the 
people -will be di,])endent upon, and rejoresented by, 
the ntirses employed by the civil government, those 
of private institutions, and lastly, but most important, 
by the native traini>d nurs{>s themselves. 

The Bureau of Health, in charge of all civil govern- 
ment hos] trds in tlie Philippines, with their accom- 
panying nunung force, directs and operates the Civil 
(!U>w the Philippine Generan, l?ilil)id, and San L.n- 
zaro, r!I of Manila; the Ragmo at the summer capital, 
the Tulierculosis at the San bian tuberculosis camj', 
and llieCulion Leper Hosiiital. It is also rcs])onsil>le 
for the medical and sanitary inspection of the islaiub. 
bcsuies aiding many private hosintals and eharitabU' 

The C^ivil Il.-pital of Manila was originally 
founded f the |)urpose of furnishing free tre.itmeiu 
to all insular government employees, besides uoing 

The Philippines 


private and emergency work. It has now been 
merged into the beautiful and commodious Philippine 
Ooneral, doing the work of any large city hospital, 
and open to all nationalities. The San Lazaro takes 
•are of cholera, small-pox, and other communicable 
' I.seases with special departments, in charge of native 
helpers for leprosy, insanity, victims of drug habits, 
^■le The Bilibid is connected with Bilibid prison 
and IS a very comi)lete new hospital with a capacity 
of four hundred beds, the work carried on at present 
I'v native attendants under direction of an American 
nurse. Pupil-nurses will soon be i)laced there for 
training. The Baguio is intended for sick and con- 
^alesccnt insular j vemment employees, as well as 
t';r the Igorots, a semi-civiliscd tribe, in the heart 
•'< whose country Baguio is situated. The Igorots 
are a bright, iriendly. tractable people, and each day 
il>e dispensary at Baguio treats and cares for a lar.4 
number of thenu New hospitals have been planned 
IT C cbu. the second largest cHty in the Philippines- 
- lOntoc. especially for the mountain tribes; at! 
>'l'ul Spnngs. and in several other sections. AH 
'" u- hospitals erected in the Philippines, with a few 
'•'■nor exceptions, are of reinforced cor -hre- 
I''oo(. earth.iuake- and storm-proof; with equipment 
'" the most moder. -haracter. and with nursing 
IKTformed almost e- rely by the Philippine trainir^g 
chool tor nurses uruler the supervision of Amencan 

The Culion Leper Colony is the lar^-esf in t h,. world 
K-re are ul present about 2200 lepers there, ar,! but 
a (ew more segregate.! and awaiting entrance-, 'i'he 
>o:npIetion ot the segregation of the Ir,..^ ,.f .u^ 


A History of Nursing 

Philippines marks an epoch in the health history of 
tlie islands. At the eolony there is a large modern 
hospital, recently completed, with a capacity of sixty 
beds. Lejjers are, of course, su!)ject to every otlicr 
disease, and the hospital treats beriberi, smali-jio.x, 
dysentery, and other tropical diseases, in addition 
to the extreme cases of leprosy. The work is carried 
on by iwo Amencan pliysicians and six French 
Sisters of Mercy. Tliere have been applications for 
a ninr.ber of American and l-]n^lish nurses desirous 
of doing this work, but thus far it has not been con- 
sidered advisable or desirable to take the work out 
of tlie hands of the Sisters, who are ver>' haj)i)y and 
contented there. Their sweet cheerfulness means 
not only a very great deal to the unfortunate lepers, 
but is a lasting inspiration to every thoughtful jjerson 
visiting Culion. The work does not mean lifedong 
isolation, as many sui){)ose. T'; non lep:ous em- 
ployees, priests, and Sisters, with proper disin- 
fecting precautions, go and come from Manila as 
often as they have the opj)ortimity. It is a great 
field for missionary work, the children of the colony 
being dependent ui)on the busy Sisters for tluir 
scliooling, moral training, etc. 

In addition to the foregoing work, three great 
health camjiaigns have bci-n started by the Director 
of 1 lealth. ( )ne is for the reductii in of infant niorta! 
ity; another, a great hook-worm eatnpaigii; and tlie 
thiril, against the omnipresent tubereulosis, a scourge 
that has attaineil the .same ajipalling stature in the 
Philippines as in other countries. Towards the n'- 
duction of infant mortality, cre<li!able \\<irk has been 
begun, chief !>• l)y I'ilipmo doctors and philanthropists, 

The Philippines 311 

eventually figure, m the way of supervision at least 
and where graduate Filipino nurses will soon be of 
inestimable value. With an infant mortahts- of 
forty-four per cent, (of total number of deaths) there 

Ltreme^r"-^^ '''' ""''' ''^ '^ ^^^^^^"^ — ' 
Investigation has shown the impaired health and 
weakened condition of the Filipino people (who are 
not a strong or enduring race) to be largelv due 
to the prevalence not only of tuberculosis, but of 
the hook-worm disease, which seems to have no 
equal in its capacity to enervate and undermine the 
system. .\ urses have thus far not entered this work 
but It IS believed tJiat the graduate male nurses will 
^oon play an import ant role in this and similar fields 
as their training has been planned particularly to fit 
them tor the general health work of the islands. 
Ihe third campaign was begim by the organisation 
ot a society lor the prevention of tuberculosis, and 
received its great imi)etus during the olficial visit of 
th. Secretary of War in 19,0. To be successful it 
must be an cduc-ational one. and must be carried on 
'v the schools as well as by the Hureau of Health 
•^ducafon concerning tho prevention n{ disease has 
been made a particular feature of the new curriculum 
o. study planned f-.r the Philippme training school 
for nurses. 

The rest of the nursing work dune in Manil.-, i, 

-oo,n„,,shc,I by the Tnivorsky Hospital, St. Pauls, 

IK Mary l„h,>son Monu.rial. San Juan ,le I )ios, 

h:'„.r.r':f :,::.''■".•■, '-■:•"*>■ - - •^^.•-■<.i«i 

. •- - ^. c.u.i^v bcus, with a lorce of 


A History of Nursing 


American nurses and a training school of Filipino 
pupils. Two selllemcnt workers are also main- 
tained here — young, enthusiastic women who are 
doing splendid work with an orj)hanage, the establish- 
ment of a most successful women's exchange, neigh- 
bourhood visiting, children's classes, f^tc. St. Paul's 
is a large Catholic institution of about two hundred 
beds, conducted by French Sisters of the order of 
St. Paul de Chartres. Here, for a couple of years, a 
training school of twenty pupil-nurses has been under 
th'^' direction of two American nurses. The nurses 
in charge, however, have recently been dispensed 
with, and the wisdom of this policy, so far as the 
pupil-nurse is concerned, is yet to be demonstrated. 
These French Sisters also conduct the Sampaloc 
Hospital, an institution of sixty beds, supported by, 
and maintained exclusively for, the prostitutes of 
Manila. The Mary Johnson is a small mission 
hospital of the Methodist Episcopal Church. A 
successful training school is being conducted here, and 
much excellent work done, particularly along the 
lines of maternity wurk and infant hygiene. San 
Juan de Dios is a vSpanish institution conducted by 
Catholic Sisters for the benefit of orphans, the feeble- 
minded, the insane, and j uii)ers. 

The Phi!i])pine Ceneral was established in October, 
1902, with Miss Julia Betts, a former Red Cross and 
ex-army nurse in charge, and two attendants for 
assistants. Tlie capaeily, then about forty beds, 
rapidly increased to eighty, with ei;;hteen nurses, 
and ten or twelve male attendants. An old Spanish 
house with .several others on the same proi)Crty had 


,i ;::,-, .A 

\t T \li 1 rri ) M ri 

ITT/l /-»f Mi^r f ': /^i I1 1 lOC 

The Philippines 


made the establishment and conduct of this hospital 
an heroic task. The practical completion of the 
Philippme Cieneral in August. 1910, was therefore a 
welcome relief to the entire citv. The new hospital 
IS doubtless one of the most beautifu' in the world 
The entire scheme is designed to accommodate one 
thousand patients. There is a nursmg force of 
twenty-five American supervisors, with about one 
hundred and hfty Filipino nurses of both sexes. 

The establishment of a training school for Filipino 
nurses was agitated shortly after the American oc- 
cupation. and a bill for that purpose was put before 
but failed to pass the Commission as early as 1903 
The project was one of the many admirable recom- 
mendations of Alaior Edward C. Carter. Surgeon 
b. S. Army, and tl.e Commissioner of Health of the 
Phihppme Islands during 1903-1905. The necessity 
of suc-h a school seemed very apparent to him, but 
new projects move slowly, and it was not until i<. 7 
that the training of nurses was introduced as a sne- 
cahsed branch of the Philipj,ine Normal School 
under Miss Mary E. Coleman, for six years dean of 
women there. To her and to Mrs. Jaim.e de \'evra 
one of the most progressive of Filipino women' 
belongs largely the credit of successfully launching 
this most iinijortant movement. 

The idea of women nursing was an entirely foreign 
-ne (o the Filijiino jjeople. To them the work 
.;* mcnnal and wholly beneath a person of anv 
tnmily or !)irlh. X(.t only did this idea have to be 
entirely overcome with b.,th parents and voun- wo- 
men, but the latter, as students, had to lie grounded 
ir, iuv very A-u-c of hygiene and sanitation, rudi- 



A History of Nursing 

mcntary knowledge which, in our country, is assimi- 
lated we know not when or how, — it is almost inborn. 
It is difficult for us to realise that some of the most 
primitive customs j)revail among persons of m.ore or 
less education in the Phihpj lines. All this was up- 
hill work, but the school was fmally started. Another 
struggle was involved in the donning of a uni'" irm. 
The Filipino has worn the same style of costume 
for about three hundred years. This dress has a 
long train which carries with it class distinction. 
It is almost symbolical of the leisure or wealthy 
upper class: the longer the train, the higher the 
class; absence of train, lack of class. To abolish 
this costume, even for the period of "duty," was, 
therefore, something to accom})lish, but it was done, 
and the student nurses now look most attractive in 
their striped, gingham uniforms, \\ ith white ca])s and 
aprons. Pleasant to relate, they have really becom.e 
very proud of them, though they return to their 
native costumes as .soon as off duty. The wearing 
of sh(jes and stockings came with this change, for 
the majority of Filipinos go bare-legged, with a 
simple sandal to jirotcct the foot. 

Miss Charlotte Layton h;ul charge of the theo- 
retical work of this school (under the Bureau of Edu- 
cation i fornbout the first two years of its e.xistence, 
or until it was turned over to the Bureau of Health 
by an act of the In^islature. The school started with 
si.xteen scholarships, ten furnished by tlie govern- 
ment, and six liy iirivatc in iividuals. After one 
year's study in the normal .schoi ', six of these student 
nurses were sent to St. Paul's for practical work, 
tiircc to iiic v^ni vcrsity, and scvcn to liic Civii iiub- 

The Philippines 


pital. After a short time. St. Paul's bought over 
ihcr SIX scholarships and used these nurses as a 
nucleus for their own training school. The Univer 
sity Ha.pital did likewise. The class of seven sent 
to the Civil Hospital remained intact, and was the 
first graduating class under the civil government. 
J he school now has an enrolment of thirty the 
maximum number of one sex allowed by law 

\\hen Miss AlcCalmont took charge of the nursing 
force in the Philipj^ines, a peculiar state of affairs 
existed All male patients, even the Americans were 
cared for by male attendants onlv. In the men's 
wards, the nurses did only desk work, charting and 
giving out medicines. Baths, treatments, and nearly 
ail surgical dressings were done by the attendants 
who were generally ex-army corps men, with even 
less Man the ordinary training. There were many 
instances of neglect, and the situation was altogether 
unsatisfactory'. It seemed impossible to get the 
nurses back into the hospital habits of the United 
States, and an attempt was made to solve the prob- 
lem by a training school for men. This at first 
was greatly discouraged, but finally put into efiVct 
with marked success. In March, lyro, a training 
school for hospital attendants was opened with an 
enrolment of sixteen pupils and a sun)risingly long 
.St of applicants. This was merged a few months 
later with the training school for young women, and 
with practically the same curriculum of study 

It n.,.t proven satisfactor>' to have the th-o- 
retical work conducted under one bureau and the 
practical work under the direction of another- n.n- 
.equeiui^. l,y an act ot the legislature, the training 


A History of Nursing 

of nurses of both sexes was i)ut under the direction 
of '' - Ikireau of Health, with Miss Mabel E. Mc- 
Cain .ont as supervising nurse, and Mrs. Eleanor 
Underbill Snodgrass as superintendent of nurses. 
Under this act, appropriation was made for >ixty 
government scholarships yearly. A thorough course 
of study was arranged, including, besides all the 
usual subjects, the nursing of tropical diseases, the 
sanitary work of the Bureau of Health, public instruc 
tion in dispensar>' and school work, English grammar 
and colloquial English, and industrial and living 
conditions in the islands. The elementary < )ursewas 
planned to cover two and a half years of satisfactory 
work, with elastic modifications to meet the sj ecial 
conditions of race and climate. The preparatory 
course of six months gives the pupils from five to 
six and a half hours daily in diet kitchens, laundr>', 
supply-rooms, etc., to familiarise them with hospital 
routine. Class work and demonstrations are given 
daily, while lessons in English are of first importance. 
Ward service is not entered on until the preparatory 
course has been successfully completed. The junior 
year has six and a hah^ hours of daily ward work, 
with one period of class daily for five days of the 
week. The senior year brings eight hours' ward 
work, with one lecture weekly, but no classes. The 
pupils, during training, pass through every branch 
of practical service. Those who have finished ' .gh 
school or have had superior educational advan ages 
aro chosen in preference to others. 

In the work of nursing and health education, which 
is of such vast significance and imjxirtancc to the 

ail nii\ r 

jieo];ic, liiCie aic oerlaii'i iiL-iu^ uiuLii ueet:,s- 

The Philipj)ines 


sitate special training for those undertaking the 
work. These are along the Hnes of adniinistr dive 
or exeeutivc hosf.i, a work; dispensary management 
and puhhc mstn,cuon: :-hooI teaching along ihe 
lines of hygiene, sanitation, and practical nursing- 
and samt.ry inspection, - the last-named course de- 
signed for tl)c male nurses particularly. Post-grad- 
uate courses of six months unll be gi^en m each of 
the .above s.ibjeets. Graduates will be selected who 
have shown particular ability along these lines, and 
dunng their post-graduate course thev wiji be paid 
thirty pesetas per month, with subsistence, quarters. 
and laundry. After completion of this course tliev 
wih receive api>ointments and salaries in proportion 
to their abdity. There are probablv no other posi- 
tions m the islands where the ■ ,rk is as remunerative 
as interesting, and of such great importance to the 
people. These special co-,rses will open up lines of 
work which it IS believed v. HI he especiallv attractive 
to the Fihpino student and f -• which it is beUeved 
he is particularly adaj^ted. 

_ To establish the Filii.ino people physically is to 
insure their future effectiveness and prosi)crity It 
should be the basis of all the educational work 
of the islands. To decrease the high infant mor- 
tality, to stamp out small-pox, cholera, tuberculosis 
malana, hook-worm, beriberi, and many other 
di- ases whuh are retarding the progress of the 
'■ihpmos IS absolutely necessary- in order to build 
scientific and industrial education on a substantial 
foundation. This great work can not be accom- 
I)Iish.d m any other way than through the education 
-•. LWL- i;co^.i^-. ana uie instruction of the 


A History of Nursing 

can only be accomplished through the specialised 
education of a selected number, who will then spread 
the leaven of their instruction, in the dialects of their 
own people, among those who have grown up in 
ignorance and sui^erstition. 

This, then, is tlie object and purpose of the Phi- 
lippine training school for nurses. These young 
men and women, from all sections of the islands, are 
to be trained not only in the care of the sick, 
but in the ])rcvcntion of sickness. They are to 
be given the best knowledge obtainable along the 
lines of nursing, hygiene, and sanitation. They are 
to be given this knowledge in such a way, it is hoped, 
that, even without expensive equipment, they can 
apply their instruction in a practical manner in the 
homes of the poor and those of moderate means. 
They will be alile to disseminate this knowledge, 
either in hospital work in Manila or in the provinces, 
where provincial hosi)itals and dispensaries are now 
rapidly to be built; in the schools, teaching it as a 
specialised branch; in the provinces, as sanitary in^ 
spcctors; or in the work of public instruction, viz., 
in dispensaries, where persons may come and receive 
free instruction in the care of the sick, the bathing, 
feeding, and care of infants, the elementary^ principles 
of nursing, the proper preparation of food for both 
the sick and the well, the prophylaxis of tuberculosis 
and other communicable discuses, etc. 

For the present, it seems wisest to spread as much 
knowledge of hygiene and sanitation as possible, mak- 
ing a feature of preventive rather than curative mea- 
sures. As the work develops, however, it will have to 
i>c more i-iiivi iiixi 

^, .^ .^ : c ,. ..4 i^. 

iX^r^ 1 ,' T 

•*^rifr *->/-*«-» 


The Philippines 


tions of the country at largo, and more particularlv 
adapted to the pvoplc of the isolated provinces. Tliis 
will be a task hcsct with difficulties. Tlie i)roblem is 
comparatively simple as far as the nurses are concerned 
who are being fitted for hospital work in Manila or 
other large towns, but for those who will be expected 
to carry their training and skill into remote and scmi- 
civihsed regions, the task is a formidable one. 

The tao or j^easant class comi)rises a widelv- 
scattered, i)ovcrty-stricken population living in ignor- 
ance and superstition, and hopelessly content to do 
so. They speak nearly sixty different dialects, none 
intelhgible to the others. To give the Filipino nurses 
a trammg adequately adapted to the i)rimitive con- 
ditions of living found in these provincial districts, 
IS the senous problem awaiting solution at the hands 
of those responsible for the training of these student 
nurses. No other educational movement in the 
Phihppines has, as yet, been thus prac licall> solved, 
and It would be a triumph almost beyond realisation,' 
if this, one of the greatest movements on foot in the 
islands, should be thus successfully launched and 
steered through *he rocky course all progressive and 
pioneer movements must run. 

The problem is largely economic. The average 
Fihpmo subsists on probably less than ten centavos 
(five cents) a day. He lives in a primitive, one- 
or two-room shack with his entire family and 
much of his live stock. Cooking utensils are of the 
fewest possible number; knives, forks, and spoons 
for eating purjioses are unknown ; the stove is a shal- 
low earthen vessel in which charcoal is burned, and 
over which the entire dinner is generallv cooked in 


A History of Nursing 

one pot or par There are no beds or bcd-lincn. 
The family bcjuat on the lloor at meal-time, gathered 
around tlio common ste\v-i)ot, and cat with the 
fingers. The diet consists generally of rice, fish, or 
chicken, and a few uncultivated native fruits and 
vegetables. No water is safe to drirk unless first 
boiled, but, needless to say, very few Filij)inos take 
this precaution. 

Among those people, skin and venereal diseases, 
tuberculosis, dysentery, malaria, cholera, small-pox, 
beriberi, and other troj)ical diseases arc liable to 
occur. Unless within r-'ach of the ccjmparatively 
few hospitals as yet constructed in the Philii)pines, 
such diseases will have to be cared for in these poor 
homes. The young graduate nurses, most of them 
from very godd families and reared in comjiarative 
comfort, all of them receiving their training in a most 
mod(Tn hospital with an unlimited amount of com- 
plicated and expensive c(juij)mert, with American 
standards of living, cooking, and eating dcveloi)ed 
almost to the exclusion of their own, -what are these 
young nurses going to do after have left the 
hospital and itN careful :.u])crvision? 

As a p'l'oplc thc\- lack the American ingenuity, 
inventiveness, and a(ia;)tal.i!ity, though, like the 
Japane c, tlic\' arc clever imitators. Hut unless 
th;y are 'aught to apply fund;',-- iital principles to 
stu'h crude conditions as have ]nvn described, tlu'V 
will surely flounder. I'nless they are trained to de- 
vise a proper di(>tary out of rice, dried fish, and vege- 
tables, realising that the only milk supply comes out 
of a tin can and at a prohibitive price; imlcss they 
can manage a hot and mid sterile water suiply with 

The Philippines 


no convenient tap to turn which would give thcni 
both; unless batliin- and cleanliness can be made 
P'^ssible with an almost total absence of soap an<l 
hnen; unless a few poor utensils can be made to 
serve the manifold needs of the sick; unless they aie 
really tramcd to do -Al this at a minimum cost/then 
only to a limited extent will their training be of u.e 
to themselves, their people, and to the countrv at 
large. And only by such measure of usefulness'and 
adaptability can the success of training Filipinos be 
Kuaged. To have a large ti ining school of bright 
c'ager young i^e.^ple, making plicnomenal progress in 
theoretical work; to have a bulging list of apphcants 
clamourMig for admission, is not enough. That murh 
onlyn.eans that these most likable, responsive 
H >pmos see their oi)i)ortunity and are ready and 
-.1 ing to do thnr part. The question is, can w. 
ana will we i^iscly do ours.^ 

['Hie work d,.;e by Miss ArcCalmont and Mrs 
Snn.igrass ,n the Philippines merits a W^^■ words „f 
'letail. Ihe former nurse, gra.luate of the Ilomao- 
I'atlnc Hospital in Washington, I J. (\. not only re- 
organised th<. entire- nursing service of the Tiv,! 
Hospital, but ai... wh.Ie hoKhng the position of 
Hospital supcnntendent. reduced the 
^">"-'- 'nvumstances of .such peculiar dinicultv as 
to make hrr work a piece of real civi,- duty, fc-arle.sly 

:Ione. for V hie h ^he nvnvcd rlu- thanks of'the admit;. 
• She al.^o designed llu- pi.-.,,, and onkn,! 
"H> e.,u,,)ment of the I'hilippine General a.s well as of 
iTovuxial ho.spitaIs for the interior. After accom- 
,^Iishing this task, she return,.! to the L-nited St ites 
and gave an interesting example of the variatirnis in 


A History of Nursinjr 

work possible for nurses, by opening a career as con- 
sultant in hospital construction and furnisl .ing. 

Airs. Eleanor Undcrvvood Snodgrass, graduate of 
the S. R. Smith Infirmary, Staten Island, and of the 
special course in Hospital Economics at Teachers 
College, was a woman whose ability and lovable 
characteristics gave promise of the brightest future. 
When she became superintendent of nurses in the 
reorganised training school, it was generally felt that 
not only success, but distinction, awaited her, — an 
outlook too soon clouded by her death only a year 
later. Miss Marga'-et Wheeler and Miss Elsie Mc- 
Closky succeeded to the direction of the work left 
by the two jMoneers.] 

The sketches of nursing development we have 
here given sIkjw, we believe, in a very striking way, 
tlu" gratlual cliange from the " sick nursing " of past 
ages to the " health nursing " foreseen by Florence 
Nightingale. The conquest of disease is rapidly 
extending, and as it does, the nurses' sphere will 
also change, until, perhaps, \hc nurse herself may 
become obsolrtc. If this d:iy comes, our " Ilistor>- " 
nia\ b^ as a voice out of the Daik Ages. 


• !u'^!'^l!^IT>"'1 '" '^^'^P^'*:^"'''^' - ^■■^•— ! character, or deal.n«,.,n m the br.,..l s.nso. ^pace do., not permit a cornplete li.t of !.t,r. 
alure on nnrMng, n,)r the inclusion of technical works.) 


Tl," History and Progress of Nursi,,^ in Poor-Lau' Infirmaries 
JOS, [) L. I).. Pledge. Westminster Rtvie,v, Aug., 1894 

The Need of a British Nurses' Association and of State Registration 
for Curses. Ethel G<.r(lon Fcnwick. Read at first HKctin,^ c,f 
A atrons .\„v. 21. iSSr: at larger one, Dec. 10, and at full meeting. 
Matrons and me.lieal men, Jan., 18S8, all at 20. Upper Wimpole St. 

The Matron. ,st An. Rej-ort. at.! The Registration of Nurses. 2d 
An. Report, Bnfsh .\ur3es AsscK-iati.m, .SSy-,,s,,o. Eth,., (i,,rdon 

The Necessity for Union amongst Nurses. Ethel G. ,rdon F enwiek 
Ine ..ursing Rrcrd, July 5, 1888. 

TheDezr/,:pnu;,l of the Art of Nursing. Ethel Crdun Fenwiek. 
Ibid., (\t. II and 18, 1 888. 

The Profession of Nursing. Eth, 1 Crdnn Frmviek. The Queen 
IS8(), and I ; unilar p.ip.T, IVronan's Herald, 1891 

The History of Nursing. Elhe! Gurd.n I'.nwick. The Que.n 

r/r,' 5f//cr Org<n;,s<;,,-o« ,,//*<- A'«fijn,? Profession. Etlul Gord-.n 
Honwtck. Re.ul by re<,uest, An. Cnnf. Xat. Union of W, .men 
Workers, i8i)7. 

.'1 Pnutual Standard of Nursing. Ethel Gordon Eenwi. k 
First A.inua! Conferente Matnms' ("ouneil, iS(j«. 

Th" Evolution of the Trained Nurse. Ethel Gordon Fenwi, k. 
J ('utiook, J. in.. 1900. 

Jrganisatton and Legislation among .V„r^,•^. Ethel Gord,>n 

'Thanks are dti. fn Miss Kmt, London, for the compi- 
Litmn of .in e.xiiausiive l.ibliograpliy whieh our limits do not enable 
us to use. 




Fcnwirk. Read at Int. Cun^'. • ■' Xurscs, Buffalo, 1901, Transactions^ 

P- 335- 

State Rrvislratinn of Frainrd Surses. EiIhI Goriion Fcnwick. 

Real at Women's Insiitute, .\(jv. 5, 190:!. 

Trained Xursii:!; as a Profession for Wonien from an F.dui nal. 
F.cononiic, and Social Asf>e(t. Ethel Gondii I'cnwick. Read at 
Int. Corij;. of Women, Berlin, 1904. 

The Organisation of the Xursinf, Profession: By Its \frmhcrs; By 
the Slate. Etliel Gonlon I^iuviek. Trans. Paris Conf., 1907, p. 

Slate Rei^islralion of Trained Xurses. Etliel Gf)rflon Fei x-k. 
Nineteenth Century and After, vol. Ixvii., 1910. p. 1049. 

Re {>ort from the Select Committee of the House of Lor' on Metro- 
politan Hospitals, Aug., 1890. 

Report, Select Committee on Registration of Nurses. Hon of 
Cfjmr.ions Papers, No. 281, 1904. 

The Queen's Poor. Mary Loane. 1905. 

Neij^hbors and Friends, 1910. Mar>' Loane. 

Voluntary Workers' Report of Poor Laiu Commissior and other 
books. Mary Loane. London. 

In Japanese Hospitals in War-lime. Mrs. Richardson. Black- 
wood & Sons, 1905. 


State Rezislration for Nurses. Louie Croft Boyd. Phila., 1911. 

A nnotaled list of Text and Reference Books for Tr. Schs. for Nurses, 
1910. Department of Nursing, and Mealtli, Teachers College. 

Louise Darcke, A Memorial. The Trained .Xurse, Sept., 1899. 
L. L. Dock. 

.4 General Presentation of the Statutory Requirements of the Different 
States. .A-iiiie W. Goodriih. Amcr. Journ. of Xursinc. Sept., 19IJ. 

Negro Self-IIelp in Hospital Work. Ge. .. C. II, iH, M.D., Chicago. 

Report of Interstate Secretary to the America): Nur.u-s' .-Isrociation. 
Isabel .Melsaae. Amer. Journ. of Nursing, .\ug., 1912. 

The F.diicational Status of Nursing. M. .\delaiilc Nulling. 
U. S. Bureau of F.diication, Bulletin No. 7, I912. 

The Department of Nursing '•.nd Health at Teachers College. Colum- 
bia University. M. Adelaide Nut ting. Read at the Iiii. Cong, of 
Nurses, Cologne, 1912. 

.1 History of Nursing, 2 vols. Nutting .I'ld Dock. Putnams, 

The Nurse in Education, Part II. M. A. Nutting and Isabel M. 



•r. for the Study of Education, 
N. Y. City Vis. 

Stewart. Ninth Year Book, Nat. 
L'niv. (,i Chica^n Press, lyi i, 

A letter on Nurse Training, Xcw York, 1907. 
Com. .,f t SU u Charitif. .^id Association. 
^^£V;.„.:-a/ Comment, .Sophia F. Palmer, Am. Journ. of 

Reports of the Congrc.s on Hospitals, Dispensaries, and Nurnn, 
Cnuago, J03. * 

R.nuntMcnces. Linda RicharcJs. \Vhitcomb& Barrows, Boston 
1 9 1 1 . I , 

Nu- ingRthus. Is '.olIlamptonRobb. Savage, Cleveland, 190, 
ducattonal Standards for Nurst . Isabel Hampton Robb. 
K -chert, CIe\eland, 1907. 

Cirailars of Information, \o. I. U. R. Education Bureau 

rrannm: Schwls for Nurses, 1882. U. S. Education Bureau. 

Rrporis on Pu,fes>.tonal Schools. U. S. Education B-ireau 

Mcdiail Inspection ,n the Public Schools. Lillian D Wald 
Ann. Am. .\cad. of Polit. and .%c. Sci., xxv.. Mar. 1905 

Educational Value and Socml .Significance of the Train-d Nurse in 
tnc Tunrculosts Campaign. Lillian D. Wald. Proceed. Int. Cone 
on , uhrrculoi: ,, Washington, 1908. 

P/.-,//.. tJ:e Creation cf a Federal Children's Bureau. Liilum 
!->■ U a . 1 nn. Am. Acad, of Polit. and Soc. Sci., .Mar., Kjfxp 

^'''-'"ig— Vocation Jor the Trained Lilliari D Wald 
Boston Woman's Educational and Industrial Union, i<)io 

The Doctor and the Nurse m Industrial Establishments. Lilli.m 
iX W al<l. Proceed. Acal. of P.Et. Sci., vol. ii., Jan., 191 . 

\ tsUing Nursing in the United States. Yssabella G. Waters 
Kussell Sage Foundation, New Y(jrk, 1909. 




le petit Personnel Medical en Anglelerre et Reformes d introduire 
nn trance. Dr. M. HI..; in. I'.iris, 1904. Thesis. 

Dans les Hofuiaux J'arisien,. Ceorg, . Cab.en. Pn'. Polit et 
Etf'irm'C. JniK--.\ii-., U)OJ. 

Con^rd .Superieure de I' Assistance Puhlique- Rapport sur le re. 

Z" ''',""'','[,"'" '^'''""""■' Seconaaire des Etablis.ements UoMtaux 
M. le d Henri .\apias, Paris, 1898. 

La Carriere de la Garde-Malad, : Le P„;i Public, 189.. , r ,8qt 
Anna Hamilton, M.D. ^•^' 

Consid/ralions sur les Infirmihes des IlopUaux. Ann.i ll.unilton 
M.D. Mniif,,!i;.jr, i9ot). Thesis. 



Instruction professionelle et Situation du Personnel secondaire des 
Hopitaux. Anna Hamillon, M.U. Reports, vol. i., Cong. Nat. 
d'Assislance Publ. et Bieriaisance rriv., Bordeaux, 1903. 

L'llir nil- di-s Ambulances de Crimee. Anna Hamilton, M.D. 
La Gardc-Malade Ilospitaliire, vol. ii., 1908, p. I. 

Florence Xightingate ((J.M.). Anna Hamilton, M.D. La Garde- 
Maladc Ilospitalikre, vol. iv., 1910, p. 165. 

(Juclqties Conseils de Mile. Ntghtinf!_ale sur les Hupitaux et le Kurs- 
tni;. Anna Hamilton, M.D. La Carde-Malade IJospitaliire, vol. 
iv., 1910, p. 172. 

La premiire Ecole Franqaise, systime Florence Nightingale. 
Anna Hamilton, M.D. La Garde-Malade Ilospitalihe, vol. iv., 1910, 
p. I. 

G-.uvre<: de Florence Nightingale. Anna Hamilton, M.D. La 
Gardc-Malade Ilospiialiire, vol. iv., 1910, 188. 

Pensies de. Florence Nightingale. Anna Hamilton, M.D. La 
Gardc-Malade Ilospilaliere, vol. v., 191 1, p. 81. 

La Garde-Malade Vtsiteust des Pauvres au Congrks de Nantes. 
Anna Hamilton, M.D. La Gardc-Malade Ilospitaltire, \' '. v., 
191 1, p. 173. 

V' Congrcs Nai. d'. Assistance Pubiique. Anna Hamilton, M.D. 
La Garde-M'ilade Ilospilaliire, vol. v., J9II, p. 84. 

Le .'<ystti,ie Florence Nightingale. Anna Hamilton, M.D. La 
Garde-Matiide Hospitatiere, Marth, 1912, p. 33. 

Plcn pour Ics Gours Theoriques d'une Ecule llospitalihe de Gardes. 
Malades systems Florence Nightingale. Anna Hamilton, M.D. 
Bordeaux, 1912. 



Ftiffkindrr der Sozialpolitik. A. ion. Ernst Rcinhardt, Mtmich. 

Vie .Siaatii he Priifun'^sordnung fiir Kranl-enpjlegepcrsoncn in 
Deut^chlari. Charlotte von Cammtrer. Int. Con/, of Nurses, 
I'ari-;, IM07, p. 177. 

Die Sihwestcr im Krankenhaus in Gegenwart und Zukunjt. Char- 
I'ttc \(.n Cammcrcr. German Nurses' Association, 22 Nurnbcr^er 
Str., Berlin, 1912. 

Notstand im '•-ut'^-n Krankenschv strrnwesen. Marie Cauer. 
^"ilschr.f. Kmnl-.ipjtege, jjp. 37, 71, 1910. 

Siaat und Krankcnpflege. Marie Cauer. Die F.auenbewegung, 
No. 5, 1902. 

Weihliche Krankenpflegr auch ein biirgerlicher Bcruf. Marie 
Caiicr. Felix Dietrieh, Leipsic, iyi)6. 



Die Berufsonanisation der Krankenpflegerinnen Deulsch'^nds. 
Agnes Karll. Dte Krankcnpflcgc, 1902-1903. vol. ii., sec. 5. Gcorg 
Reimen Berlin. ^ 

Die Not'xeyidigkcit cincr ausrcichenden Alter si'ersore,ung Jur dan 
Pflegepersonal. A^ncs KarU. Die Krankenpflege, 1902-^ vol 
>i., sec. I. .' o • 

Dte Berufsorganhalion dcr Krankenpflegerinnen Deutschlands 
Agnes Karll. Neue Bahnen, 1903, \o. 5, Richard Schiridt. 

L'.e Krankenpflege auf dem international en Frauenkongress in 
Berlin, 1904. Agnes Karll. Deutsche Krankenpflege Zetlung iqoj 
No. 14. ^ "*■ 

DiePjUcht:-nderAcrztefur die Entincklungder deutschen Kranken- 
PJlcge. Agnes KarU. Zeitschrift J. Krankenpflege, 1907. No 1 1 
p. 321. ■ • 

/)/c neue Priijungsordnuvg fur Kraniienpflegepersonen. Agnes 
Karll. Medizintiche Reform, 1907, \o. 12, jj. 145. 

Z)t« Geschtchle der Krankenpflege und ' ihrc ' Bedeutung fur dte 
Frauenbrau-gung. Agnes KarU. Centralhlalt d. Bund De Jscher 
Frauen Vereine, N'o. 17, p. 131. 

Krankenpfl.ege und Frauenbeuegung. Agnes Karll. Die Frauen- 
bewegung, 1910, \n. 23, p. 1S3. 

Geschichte der jUnf rrsten Jahrc unieres Verbandes. Agnes Karll 
Reprint from rnlerw Lazaruskrcuz. Jan. 15 to Aug. 15, lyoS. 

Die Geschichte dcr Krankenpflege. Agnes Karll. In 2 vols 
Translated fruni the i:nglish, Dietrich Reimcr (Emst Vohsen)' 
Berlin, 1910. ' 

nahnbrerhendc Frauen in der Krankenpflege. Agnes Karll 
Bahnbrechende Frauen, p. 305, Lyceum Ciul., Berlin, 191J. 
^^ . 1 ntra^ auf staatluhe Prujung der Krankenpflegerinnen. Elsljcth 
-vrukcnlierg. Die Krankenpflege, 1902, pp. ^57-S6I. 

Pie sozudr und . .hlluhc Lagc der Krankenpflegerinnen. r,.^ 
Luders. Soziale Praxis, \i>. ^i, i<)io. 

Religion und Krankenpflege. Marthe Ocsterlen. Deutsche Kran. 
kenpfl. y.etrg, i , ;,. jui, 1^98. 

Arbeit.verhultnisse in der Krankenpflege. Charlotte Rcichd. 
Soz. Praxis, N'o. 27, 1910. 

Der Piensk'e'trag der Krankenpflegerinnen unter B riickuchtigunr 
der Sozialen Lage. Charlotte keidiLl. Fi.schor. Jena. 1910. 

I.age dcr Krankenpflegerinnen ^ Charlotte Reiehel. Zeitsehr. 
f. Krankenpflege, ,\o 57, lyio. 

Srlhsthilfe und Soziatpol:t,k. Charl. ttc Reiehel. German Nirst-s* 
Association, 22 iNurniicrger Sir.. Berlin. 




Die freii Krankenpflcgerir.. Elisabeth Storp. FrauendiensI, 
pp. 28-3^^, 1902. 

Die soziale Stellung de- Krankenpjlegerinnen. ElisaVjcth Stc.rp 
Drcstiin, 1901. 

Zur Krankenpflegerinnenjrage. Elisabeth Storp. Die Krankcn- 
Pflege, p. 270, 1902. 

Die Wirtschajtli.he und sozialt Lage des Krar.kenpflegepersonali 
in Deut!,chland. Gcurg Streiter. Fischer, Jena, 1910. 

Pticgeverhand im Verglnih zur Jreien KrankenpJIei^r. C. von Wall- 
nicnieh. Bld'ter d. bayr. Frauenvcreins v. Roten AVfttr, p. 273, 1902. 

Die Stellung der Oherin im modernen Kranker.kaus. C. von Wall- 
mcnich. Munich, 1902. 

Sclhslverwaltuns, in eiuer Schwesternschaft. Friedrich Zimmer. 
Die ZcU, No. 50, 1902. 


Per le Scuole dellc lufcrmtere. Anna CcUi. Nuova Antolog-.a, 
CkU, 1908. 

Woman's Work in the Red Cross Society. T. Goranson. Stockholm. 

Articles by " Ih.IUindia," in BriHih Journal of Nursing. See fil'js, 
1904 to date. 

I lei Rapport van deti Centralen Gezondheidsraad. J. C. \'an Lan- 
schot Hubrecht. Nosokumos, Sejit.-Oct., 191 1. 

The Fight agai. Tuberculosis through Dispensaries. Emmy 
Liiulliagcii. Siockholm, 1910. 

Florence Mightingaie and thz Reform oj Nursing. S. Ribbing. 

Riforma dell' Assistenza ospedaliera. Amy Turton. Rivis'a 
dc' -1 Beneficenzia Pubblica. 


.imerican Journal of Nursint;, The, 226 S. 6th St., T hila., Pcnna. 

Australasian I'r. .\'urses Journal, 'Flic. Sydncv, X. S. \V. 

British Journal of Nursii:g, The. 20, L'p])cr Wimpole St., Londoa 

Canculian Nur<e. The. McKinnon B'lM'g., Torr nto. 

De Vlamschi- Vcrplcging. Antivcrp. 

Epionr, KopmaiisgaLan 6. llelsingfors, Finland. 

Kul Tiaki Government Rldgs., We' i.^rton, .\. Zealand. 

La Garde- Maiidr llospitalihe. 96'''', nie [.aroehe, Dordeaur. 

Nosokomos. 15 \'an Eei;hen Sir., .Xmsterdam, 

Nurses' J'vurnal of the Pacifii. Cocst. San Francisco. 



Nursing Journal of India. Bon Espoir, Ootacamund, South 

Swedish Nurses' Journal. 25 Tunnclgatan, Stockholm. 
Tidsskriftf. Sygepkge. 50 Kronprinscssegade. Copenhagen. 
Una. Equitaljle Bldgs., Melbourne, Australia. 
UnUrm Lazaruskreuz. 22 Numberger Str.. Berlin, W. sa 





Acts of Parliament 'elating to 
nursing. See ICngland 

Africa, iv, 222-228 

Campbell, Emily, work of, 
223: Chevalier, .\Inie., life in, 
226; IJufTerin I'und in, 226; 
English nurses in, 222; Ger- 
man deaconesses in, 223; 
Henrietta, Sister, work in 
Kimberly, 226; state registra- 
tion of nurses in, 226- ■22H; 
training natives in, 224; 
Universities Mission, 225 

Almshouse nursing reform. Scr 
U. S. 

Aletrino, Dr. and Mrs. See 

Allerton, Eva. 5tr U.S. 

All Saints Sisters. See India 

Aloysius, MotherM. .SVelrcland 

Ampthill, I ord. See England 

.\rmy nursing. See name of 

Australia, iv, 172-189 

.Adelaide General Hospit.'d, 
176; .Mfred Hospital, 174; As- 
sociations of nurses in, 177- 
179; Australasian Trained 
Nurses' Association, 177-178, 
I«2; Hrishane Hospital, 176; 
luish nursing, 186; early nurs- 
ing histt.ry in, 172-174; Farqu- 
harsnn. Miss, 174; Melbourne 
Hospital, 175: mental nursing 
in, 181; McGahey, Susan, 
work of, 174: midwifery in, 
189; Nightingale nurses in, 
173-174; nursing journals of, 
184; organisatiou in, 177; 
Osbum, Lucy, 17.^; Prince 

Alfred Hospital, 174; public 
Schools nursing in, i«7; regis- 
tration; by the state, 182- 
183; voluntar\-, 180; Royal 
British .\ur;es' .Association'in, 
177; Royal Victurian Trained 
Nurses' -Association, 177-179; 
Sydii v Ho.spital, 172; Talbot 
Milk institute, 188; Tasmania, 
Nightingale nurse in, 173 
Average working period German 
nurses, iv, 45 


Baxter, Grace. See Italy 
Belgium, iv, 74-78 
CavcU, Ali^, pioneer Matron 
in, 76, 78; Ecole beige d'lnfir- 
mieres (iiplomtk?s, 76; muni- 
cipal schools in, 75, 78; outline 
of early history of, 74-75; 
physicians' interest in nursing 
refonn. 78; state registration 
in. 76-77; 
Bibliography, iv, 3-3-329 
BhukwcHjd, Hermione. See Ire- 
Bottard, Mile. See France 
Boumevillc, Dr. See France 
Bre.iy, Margaret. See England 
Brodrick, Albinia. See Ireland 

Canada, iv, 122-170 

Alberta, hospitals in, 141; 
army nursing. 149-150; Brent, 
Louise. 143; British Columbia, 
nurses in, 142; {^"atholic orders, 
training schools under, 124, 
'37,1.39, 140; Columbian Coast 




«NS1 ,,nu ISO lEST CHART No 1: 


■ •- 2. 
3 i 


, — 

il 2.2 

11 =^ 

1. L' 





^ /iPPLIED liVMGE Inc 



Canada — Coi'iucd 

Mission, 142; early Frrncli 
liospitals, 123-124; educa- 
tional standards in nursing, 
158-160; Female Benevfiknt 
Cociety of, 135; first secular 
hospital, 125; French regime, 
122; (jrey Nuns in pestilence, 
i.?'^>-'37; hosi)itals fur child- 
ren, 143; Kiiigrilon Compas- 
sionate Society, 135; Living- 
ston, Norah, 129, 134; Mac- 
kenzie, Mary A., 166; Mani- 
toba, nursing in, 140- mental 
nursing, status of, 147-14S; 
Milk Commissiiin, 156; Mont- 
real, first tr;iining in, I2h\ 
General Hospital <•!, reforms 
in, 128-121); new lines of nurs- 
ingwork, 161-162; Nightingale 
nurses in, 128; nursing journal 
of, 167; organisation in, 162- 
l65;()tta\vaCicncTal Hospital, 
137; post-gra(kiate courses, 
158-161; preliminary courses, 
130, 138, 159-160; public 
schools, nursing in, 156-157; 
Robertson, J. Ross, 143-144, 
157: Royal Victoria Hospital, 
I38;Saskatehewan, 141 ; settle- 
ment work, 156; Sisters of 
H6tel-nieuof Montreal, 138- 
1^9; Snively, M. A., hos- 
pital work of, 133; public 
work of, 134, i5(). 163; state 
hospitals, 144-149; Torontu 
General Hospital, history of, 
130; training school of, 131- 
132; tuberculosis nursing, 157; 
Victoria (k'neral Hospital, 
134; \'ictorian( 'rderof Xursi s, 
the. 151-155; Winmpig Gen- 
eral Hospital, 140; Suknn, 
nursing in the, 142 

Canadian Presbyterian Mission. 
See India 

Catholic Nursing Orders; atti- 
tude toward registration in 
Belgium, iv, 77; in Gennany, 
iv, 30; in U. S., iii, 149; Can.'i- 
tlian hospitals, work in, iv, 
124; plague son-ice in Canad.i, 
iv, 136-137; revival in Ireland, 
iii, 85; statistics of health, 

middle Europe, iv, 37; Ftatus 
in Frrmce and It.aly (see tliose 
countries); training school 
wi)rk of. See Canada, Ireland, 
and U. S. 

Cel'i, Arna. See Italy 

Chaptal, Mile. See I''mnce 

Clnna, iv, 277-285 

Central China Medical Asso- 
ciation gives certificates, 283; 
Chesnut, Dr. Eleam<r, work 
and death of, 281; Chinese 
nurses in as.sociations, 282; 
in hospital positions, 279; 
Chinese training school at 
Tientsin, 284; Chung, Miss, 
Matron of, 284; early nursing 
work in China, 277; Elisabeth 
Bunn Memorial Hospital, 27S; 
Hart.Mrs. C.M.,2M3;Kin, TJr. 
Yamei, hospit;d work of, 284; 
Margaret Williamson Hos{)i- 
tal, 278; Nurses' Association 
of China, 282; St. Luke's 
Hospital, Shangliai, 278; Tip- 
pett. Miss C. F., on mission 
work, 281; uniform standards 
of training proiiosed, 282 

Corea, pioneer work in, iv, 285 

Cuba, iv, 288-307 

American nurses in, 298; 
Cuban nurses at London 
C'ongress, ^12; I?ept. of Chari- 
ties and Nursing, 296; emer- 
gency work of Cuban nurses, 
305; first in ho>pital posts, 
299; Hibbard, Ikigc^nie, career 
of, yy)\> organisation work 
of, 295; hospital conditions 
;it end of war, 288; Kean, 
.Maj., share in nursing reform 
of, 2<)3; mental nursing, 303; 
Mercedes Hosjiital first tr.iin- 
ing .school, 291; O'Donnell, 
Mary A., first training sdiool 
siii>erinten<lent, 2<)2; org.mi- 
sation in, y)ii; ])reventive ,ind 
social work. 3<h>-3oi; regul.i- 
tions ()f training scliools. 296- 
297; reorg.inisation in 
h<-s])itals, 290; state registra- 
tion establi.shed, 297; training 
sch()ols opened in .sefpience, 






Deaconesses. See 

Delano, jane A. See U 
Denmark, jii, 254-263 

Danish Nurses Association, 
25'Vr59; activities of, 2O1 ; 
petition to Minister from, 262 ; 
Deaconess Institute, 2S4; Fen- 
Ror, Dr. C. E., w. .rk of, 2s6; 
Lutken, Cecilie, 2^ii; Norrie, 
C harIottc,259; nurses' journal, 
?62; Red t ross orpnis^ition, 
256-257; rural reform, 
2S>^: St. Lucas' Institute, 256; 
1 scheming, Mrs. Hennv, 2><» 

Department <,[ Ilosijital Econo- 
mics, iii, 132 

District nurting. See name i<f 

Doria, Princess, iv, 107, no 

Drown, Lucv, iii, i2« 

Dufferin, Countess of. See 

Eight hour day in hospital New 
Zealand, iv, 2ly; U. S. iii, n5 

Elston C'athiirine. See France' 

England, iii, 1-61 

Acts of J'arliament relating to 
nursing: Asylum (.fficers' su- 
perannuation, 8; Education, 
28; Midwives, 27; \otifu;i- 
tion of hirths, 27; Poor law 
orticers supiTrmnuation, 4; 
Ampthill. Lord, chamiiions 
registration, 58; Army Nurs- 
ing, icj; Hreay, M.irg'aret, in 
sun against ot]icers R. 13. N. 
A.. 50; in wi.rk for ^^•lfrnns' 
( ouncil. 53; Hnltsh Journal 
of .\uritni;, .V}; British Nurses' 
Association foumled, 33; City 
financiers' scheme to' contn 1 
nurses, 57; district nursing, 
liegmnmgs of, 23: Fenwick, 
Mrs. liedfonl, organisati(.n 
begun by, 32; government 
service, nurses in, 18-21 ; Guy's, i!it>icult reforms at, 
2; regidations of, ]■^■, ]h,][. 

ftckley system, 25; Hospitals 
( ommittec, policy of, ^7; 
Hughes, Amy, 27; lady pupils' 
13: Leagues founded, 54; 
Lnanc, .Miss, 30; Local govern- 
ment hoard, 4, 8. 9; Loch, 
Miss. 20: Manson,' Ethel 
Gordon (Fenwick), 31; Ma- 
tron, the, r6; -Matron's Council 
founded, 52; mental nursing, 
21-22, midwifer%-, 30; Monk, 
Katherme, 2; National Coun- 
cil of Nurses founded, 55; 
nurse .nspectors. 9; A'ur.y'nig 
Record, The. 34; Pearse, IKlcn, 
28; pioneers in nursing ref<;rm, 
1-2; Plaistow nurses' home, 
26; I'oor Lawinfimiaries, 3-6; 
I>reliminary training, 12; pub- 
lic .school nursing, 27; Ouecn 
Victoria's Jubilee Institute, 
17-22; relief of sickness, how 
organised, 3; royal charter 
gained, 42-43; .Select Com- 
mittee on registration, report 
of, 56; .State registration jto- 
posed, 36; .State Society for 
registration formed, 55; Stev- 
ens,,n, Louisa, 56; 'stewart, 
Isla, 52; struggle for organis.a- 
tu,n, 30-60; Twining. Kathe- 
rme, 26;, 7; !:nion of 
forces to work for registration, 
5«; vdi.ige nurses, 25; w,,rk. 
houses order in nursing, 8 


I'cnwirk, i:thel C;ordon 

l'"inl,ind, iii, 263-275 
Associ.ation of nurses of, 273- 
275; Hroms, Anna, 27();'iarlv 
nursing in, 263; first gencra'l 
h"si)ital in, 265; House of 
De.iconesses, 267; Karamxinc. 
Mme., 267: Lackstrom. Mrs. 
( Mga, 271 ; Mannerheim. Mme., 
271: NiK'itingale, advice ,,nd 
put of, 274; nursing journal 
'.'b 275; preliminar>' training 
m, 274; Salt/.mann, Dr. F 
2fx>; Sister Lina. 268; Surgical 
llo.pital. Helsingf(,rs, 270- 



Finland — Continued 

t iirce years' course established, 
272; Onivcrsity Clinics train- 
ini^ school, 272 

France, in, 279-340 

Army nursing established, 32 ^ ; 
Augustitiians in Roucicaiit 
Hospital, 340: k'ave Hciti 1- 
Dicu, 279; Bordeaux schools, 
316; Bottard, Mile., life of, 
284-2^5; Bourncville, I'r., 
story of, 2M9-291; Bni, M., 
novel by, 337; (."haptal. Mile., 
work (jf, 339 ; Circulars, otlieial, 
on mirsmg, 330-331; c^^rly 
reforms in nursing, 282-280; 
early te<uhing of nurses, 295- 
296; Kcole professionnellc, nc w 
s-hool in Paris, 334, 338; 
Eiston, t.'atlierine, work of, 
309; Hamilton, Anna, at Con- 
gress Public and Private 
Charities, 332; letter from, to 
Red Cross International Com- 
mittee, 326; personality of, 
299; story of, 3(X)-3o5: La 
Gti rde- Malade Ilaspitaliirc, 
328; Lande, Dr., active re- 
forms of, 310; death of, 329; 
Luigi, Mile., at Beziers, 319; 
at Rlieims, 320; Maison de 
Saute Pnjtestantc, 305-308; 
Mi'SuriMir, M. (•.. article on 
nursing reform, 33).; municipal 
courses for nurses, Paris, 292; 
provinces. 331: new scliool for 
nur-^es, Paris, 334; .Nightingali' 
influence of, in France, 299; 
nursing journal, Bordeaux, 
328; Nectoux, Mile., in Albi, 
321 ; numbers of nurses, I'aris, 
329; organisation of I'aris 
hospitals, 335; Pasteur, influ- 
ence 'A. 280-281; proi>lems if 
Paris I'.ospirals, 337; provincial 
hosjiitals. Burdeaux nurses in, 
311) 320; public school nursing 
in Bord>>aux, 328: in Pari-, 
339; Red Cross methods "\ . 
306, 308: Regnault, Dr. Felix, 
on hosi)ital system, 333; regu- 
latu.n of May i, 1903. 334: 
Sabrin. M.. views as to Ma- 
tron's position, 333; School nf 

the Rue Amvot, 297; Sisters 
of .Mercy m Pasteur Hf)Spilal, 
340; St. Andre, nurses' diary 
in. 313; training begun in, 31 1- 
312; Tondu Hospital, ir.ain- 
ing in, 315; visiting nurse io 
Bordeaux, 327-328 

C/erm.any, iv, 1-51 

Arendt, Sister Hcnriette, 
author of White Child Staves, 
34: average working period of 
nurses in, 47; CatlioHc nursing 
orders in, 2; numbers of, 51; 
Uiakonie Vcrein, 5; Hppen- 
dorf-llamburg nursing associ- 
ation. 3; Fne Sisters, the, 7; 
German Nurses Association, 
iiranches of, 21, 33; founded, 
16; growth of, 20; relations 
with Dusseldurf Hospital, 
26; with Frankfort City Hos- 
[, 23; Hecker, Dr., article 
by, 51 ; Kaiserswerth and Cha- 
rite, 36; KaHl, Agnes, early 
articles by, 8; letters of, 30- 
32; principles urged by, 9; 
story of, 10-24; Lazanis cross 
chosen as symbol, 25; legal 
status of nurses, 48; morbidity 
and mc't'.ality st.atistics (jf 
Cierman Nurses' Association, 
3<)-46, of Von Lindheim, 37; 
Nightingale nurse in Cermany, 
3; nursing juurnal founded, 24; 
numbers ( if nurses to patients, 
4()-5i; overstrain among 
nurses, 36, 38: Red Cross 
inothcrhouscs, 4; Reichel Frl., 
investigations of, 48; social 
service and new lines of w.irk, 
33-34; St.ite registration at 
( li.irite, 18; conference on, 29; 
establisheil by Hundesrath, 27; 
stand, irds of, 28-29; St. John, 
cinler of, (1; St<iri), Elisabeth, 
p.iinphlct by, II; Vntrrm 
LdZdruskrruz, 24; opposition 
of Red Cross to symbol. 26- 
27; Victoria House, 2; Virchow 
piiiposals of, 2; Wiesbaden 
meeting passes resolutions, 



Germany — Omlinucd 

14-15; \v(.nian movement and 
nursing reform, II, 30 


ITampsnn, R.ira. See Ir land 
Hampton, Isahel, See U. S. 
Haui;lit(;n, Louisa. See Ireland 
HenUy, hospital poems, iii, 68-(>9 
Holland, iv, 55-74 

Aktrino, Ih. and Mrs., work 
of, 6,^; "Bond," the Dutch as- 
sociation for sick nursing, 57- 
59,61 ; early nursing conditions 
in, 55; M(un:dhlad, hospitals 
journal, 59; Matrons, weak- 
ness of, 59; Nosokomos, nurs- 
ing' journal, established, 6J-64; 
headquarters of, 74; Reyn- 
vaan. Miss, work of, 57; state 
registration demanded, (jS; 
government rei)ort on, 72; 
mei ! ical men 's a 1 1 i t ude to war. ! , 
69; state registration society 
formed, 74: van Lanschot 
Hulireclit, Miss, work of, 64; 
\iewpoinL of, 65-67 
Huxley, Margaret. See Ireland 



I-dward Ilospita 

India, i\- 

AllaTt i:dward Hospital. K( _ 
hapur, 246; All Saints SistiTs, 
244; American lilvangeiit al 
Lutlieran Mission, 247; As- 
soci.'ition nursing suinTinten- 
dcntsof India, 249; CamaHo-^- 
pital, noui!)ay, 241; I-^nglish 
Baptist Zenana Mission, 2^h; 
first training school for nati\e 
nurses, 241; midvviferv, st.atus 
of, 2,v); Mills, Miss, 245; 
Miutci, Lady, nursing associ- 
ation, 251; missions advance, 
2.^! , .\ational .Association sup- 
plying medical aid, 2.^,^; ob- 
jects of, 2,V5; Nightingale, 
writings on India. 229; .Nortli 
India Scltool of Medic'ine, 245; 
A'Kr.sfwi; Journal of India, the, 
249; org;inisati<in in, 254; 
plague niirsinjj incident i^f, 

243-244: registration in Bom- 
bay Presidency, 251; in Nurs- 
ing Journal, 250; Scva Sadan, 
the, 252; Thorpe. Winifred, 
255; Tindall, Miss, 242; 
Trained Nurses' 'Association, 
249; uniform training, work 
toward, 250; U. F. Church -.f 
Scotland Mission, 248; Zena- 
na Bible Missi(,n, 242 
Ingenliohl. See Switzerland 
InttTnational Council of Nurses, 

inception tif, iii, 54 
Ireland, iii, S2-1 15 

.Moysius Mother, testitnonials 
to, loo-ioi; Bnjdrick Albinia, 
work of, 115: Cath(j!ic C)rdiTS 
training schocd work of, 97, 
104; Children's Ilosintal, 
Dublin, 9S; City of Dublin 
Nursing Institute, 96, 104; 
Dun's Hospital am! Nursing 
Institute, 9,1; early hospital 
history, 82-84; 'irst schodl 
for Catholic nurses, 92; Han- 
nan, Miss, work of, 102; Irish 
.Nurses Associatic^n, 110-113; 
Irish nursing, 11,5; 
Kelly, Miss B., work of, 92, 
97; NIacDonnell. .\nnie, work 
"f, 95; Mater Inf., 
H.lfast, loi; Mater .Miser., 
Dublin, 100; Mercy Hospital, 
Cork, 99-100; .Nightingale 
Nurses in. 91, 9,S. i<M; I'ringle, 
Miss. Work of, 102; Queen's 
mirx'S in Ireland, io()-ioh; 
( ':<reii's A'lines' Mag^azin:. 1 10; 
Kt'ligious order . reviv;d of, 
.^5; kotund;i Hospital, changes 
in, 95; Sister M. Alliens lo- 
garty, 102-104; Sisters i.f 
Charity in Cork, 8(>; in Duii- 
lin. 85; Sisters of Mercv in 
C'.rk. 8(); to Crime;i, ' ,S6; 
.'--■'iith Ch.aritablc lnlirm,ar\-, 
("ork, 102; Steevc-'s Hiispital, 
history and nursing i>f, ^3, 
.SH-<>2; St. rhilom(-na's train- 
ing school, 101-102: Treacy, 
Mrs. Kild.irc. 107; Trench, 
.\rchi>ishop, uork of. .S7 
Italy, iv, 7<)-i 17 

B.irricrs ti. niiHlcrn svstem. h(y 






lialy — Continued 

Baxter, CJrace, letters of, loo- 
lod; I51ue Cross Society, loo; 
Catholic orders, their niirsint^ 
work, Sj, 114; Ci'lli, Anna, 
article on early conditions. 79; 
on later c(jndit ions, 8 1-85,1 14- 
115; comparative numhcrs 
of nuns and nurses, 1 14; Con- 
gress of Itali.-in women, 107; 
passes resolution on nursin^^, 
loH; Doria, I'rincess, 107, lot): 
NiRhtingale, Miss, influente 
in Italy, 8y, 1\2; opening of 
new school for nurses, 112- 
11,^; Ospedale Gesu e Maria, 
Miss Baxter's work in, 99; 
I'<iliclinico, Rome, field of new 
school. III; Scuola Convitto 
Regina li^lena, 117; Snell, 
Dorothy, work of, iii; Stron- 
goli, Princess of, part in nurs- 
ing nform, 99-100; Tonino, 
Signorina, work of, 106; Tur- 
ton. Amy, a pioneer, 80; dia- 
ries of, 91-98; stor>' of, 87-91, 
i<)<)-ii3; views of, on nursing 
in Il;ily, 1 15-116 


Japan, iv, 256-277 

American nurses in, 276; 
charity hospital in, 257; Civil 
hos])itals, 274; cflicicncy (f 
Japanese nurses, 276; Trst 
training school in, 25S; Ilagi- 
wara. Take, at London Con- 
gress, 259, 275; Nightingale, 
influence of, 277; Komcyo, 
Km press, legend of, 256; Mc- 
Civc, Anita, expedition of, 27(1; 
nurses in Reserve hospitals, 
274; Red Cross nursing organi- 
sation, account of, 2(ir>-J7,^; 
Relief nurses, 202; Richar(h;, 
Linda, in, 257; sanita- 
tion, triumphs of, 275; Suwo, 
Choko, Work of, 276; volun- 
tary nurses, place of, 265; 
visiting nur-^^iug, initiation of, 

Journah i\f Xiirsinn. See under 
countries antl bibliography 

Lai 'rador, coast mission of, iv 

La Source. See Switzerland 


Mental nursing, ^ce under name 

of country 
Midwifery. See under name of 



Negro nurses. See U. S. 

Newfoundland, nursing in, iv, 

New Zealand, iv, 189-222 

Army nursing in, 222; Auck- 
land Hospital, 190; Back 
Mocks nursing, 290; Christ 
Church Hospital, 195; coun- 
try hospital work, 221; dis- 
trict nursing, 211; Dunedin 
Hospital, 197; early history, 
189; first training school, 
194; government in.pection 
of hospitals, 201-202; Kai 
Tiaki, 216; legislation on hos- 
pitals and Iiealth, 2i<)-2i7; 
Maclean, Hester, work of, 
209, 215; Maori nurses, train- 
ing of, 213; mental nurs- 
ing, 218; midwifery, 206-208; 
Neill, Grace, work of, 202; 
Nelson Hospital, 200; nursing 
journal, 2i(): organisation of 
nurses, 215; R. B. N. A., 202, 
203; Seddon, Mr., tribute to, 
209; society to promote health 
(>f women and children, 212: 
state maternity hospit.als, 207; 
state registration of nurses, 
203-206; Trained Nurses, 
Association, 215; tuberculosis 
nursing, 218; Wellington Hos- 
[lital and m.atrons, i94-i()5 

Nightingale. Florence, comment 
on registrati<'n, iii, 43; ikath 
of, iii, 61; influence in Austra- 
li.i, iv, 173-174; in Finland, iii, 
274; in Frame, iii, 299; in Ire- iii, 91-95, 103; in Italy, 



Nigh tingale, — Continued 

iv, 89, 112; in Japan, 277; in 
Johns Hopkins Hospital, iii, 
122; in Sweden, iii, 240; Mnga- 
zine, The Nig,htin^ale , iii, 119; 
Nightingale nurses in Austra- 
lia'' '73. '74; in Canada, 128; 
in Germany, y, in Ireland, iii, 
91.95. io2;in New Zealand, iv, 
200; in .Scotland, 66, 72; in 
Sweficn, 242, 2 J 8 ; in Tasmania, 
iv, i-y. writings on India, iv, 

Norway, Red Cross nursing of, 
iii, 276 

Nurses Settlcme:its. 5ce U. S. 

Persia, Toronto nurs.' in, iv, 287 
Philippines, The, iv, 307-^22 
American nurses in, 308; hos- 
pital organisation in, 3o8-3(X); 
MoCalnKint, Mabel, work of, 
315-321; men niirses for, 315; 
problems of public health, 31 1 ; 
Snodgrass, Mrs. E., death of, 
322; training school .oiiiided, 
Porto Rico, pioneer work in, 
iv, 307 


Queen's Nurses. See England 


Scotland, iii, 61-82 

Aberdeen, Royal Inflmiarv, 
74775; Allen, Dr., 78; Barclay, 
.Miss, first traine<l superin- 
tendent, ()6; Bell, Dr. ]., 72; 
Deaconesses in Scotl.ind, 68; 
district nursing pioneers, 23, 
75; Dundee infirmary, reform 
in, o;; early nursing history 
61, 66; Edinburgh, Rova' In- 
firmary, 61-66; fever hos[)iial 
nursing, 78; Glas>.;ow R-rval 
Infirmary, 70-71; Henley, 

hospital poems of, 68, 69; 
local Government bcwrd, nu.s- 
ing under, 7(>-77; Lumsden, 
Rachel, work of, 75; mental 
nursing, 80; midwifery, 80. M ; 
organisation, 81; Porter, Mrs. 
Janet, 68; preliminarv courses, 
73; Pringlc, Miss, wo'rk of, 72; 
registration movement in 
Scotland, 81 ; sanat(..rium nurs- 
ing. 79: '"Sinclair, Mrs., work 
of, 78, 79; S[)enccr, Miss, 72; 
Strong, Mrs. Rebecca, 67, 71, 
73; Western Infirmary, Glas- 
, go w, 73-74 
Spain, iv, 1 17-12 1 

Foundation of Rubio Insti- 
tute, 117; training school in, 
IVC; Zomak, Sister Marie, 
work of, 120 
Sweden, iii, 237-254 

Army ;ind navy nursing, 250; 
Deaoinesces in, 230; district 
nursing 'n, 250; early nursing 
history, J37; Fredrika Bremer 
Associati<;n, 247, 250; Insti- 
tute of deactjnesses, 238; <jf 
d^eacons, 247; Lindhagen, 
F'mmy, 252; nursing journal of 
Sweden, 251; or anisation de- 
veloped, 252, Rappe, Emmy, 
240; Red Cross Society and 
nursing, 238, 240, 242; Rodb.e, 
Estrid,25i; Sabl)atsbcrg Hos- 
pital, 246; Samaritan Home, 
245; vSophiahcmmet, the, 242, 
244; S(juth of Sweden .Nursing 
Home, 246; Tamm, Therese, 
253; tuberculosis work, 252 
Switzerland, iv, 52 -55 

Deaconesses in, 54'- Gasparin, 
Mme. fie, 52; Ingenbolil, 
nuns of, 54: La Source train- 
ing .school, 52-53; organisa- 
t>"n, 53. 54: l^cd train- 
ing school, Berne, 53; Zurich, 
training school in, 53 
Syria, work of Miss 'WorUhct 
in, iv, 286 

Turkey, outline of pioneer work 
m, iv, 286 





United States, iii, 115-236 

Affiliation for tniining, 186; 
first examples of, 118, 123; 
armv nursinji; bill, 21 1 ; Allcr- 
ton.'Eva, work of, 14H; AUinc, 
Anna, work of, 133, 152; 
almshousenursing reform, 221, 
228; alumna' societies, 120; 
Americdn Journal of \'urshiv,, 
198-1 99 ; Americai '-Indian 
nurses, 192-195; associated 
aluinn.T founiIe<l, 128-129; 
Buffalo Nurses' Association, 
147; Catholic orders and regis- 
tratioTi, 149; Cleveland Visit- 
ing Nurse Association, report, 
233-234; Delano, Jane A. ,211: 
Urown, Lucy, 128. Hnu- 
CATioN — action of Miss Ban- 
field on, 139; Beard, Dr., 
standards of, 139; Committee 
on, 132; j;ro\vth of, 131; Ilurd, 
Dr., attituile toward, 13^; 
Isabel H. Robb scholarsliip 
fund, 134; Mills, Prof., action 
of, 139; report hospitals com- 
mittee on, 138; Teachers col- 
lege course,' 131-134; Texas 
university, action of, 139; three 
years' course, 135. Ethics, 
first book on, 119; examining 
boards, {see names of states) ; 
Fenwick, Mrs., in U. S., 125; 
Got'drich, Anna, work of, 153; 
Grettcr, Mrs., in Detroit, 135; 
Hampton, Isabel, 122-126; 
health talks by nurses, 230; 
Johns Hopkins Hospital 
opened. 121; journals of nurs- 
ing, 198, 200; Lent, Mary V.., 
paper by, 234; Maxwell, Anna, 
at Chickaniauga, 205-210; 
Mclsaac, Isabel, work of, 201 ; 
mental nursing, 139-140; 
Naval Nurse Corps, 213; 
Negro nurses, I95-IO8; A'l'^/i/- 
inZiile magazine, the, ii<): 
Nurses Settlements, 215, 221- 
223; Nutting, M. A., work of, 
133-135; Palmer, &>phia V. 

143, 145, 147, 148. pioneer 
authors and nurses, 118-119; 
preliminary- course, first, 134; 
public school nursing l)c- 
gun, 224; Red Cross Nurse 
Corps, 212-213; religious or- 
ders, 1S7-192; Robb, ^lrs., 
129, 130-132, 134, 142, 146, 
202, 211; Rogers, Lina, work 
of, 224; schii()l for district 
nurses, 231 ; Sisters of Mercy, 
Chicago, 187- 1 89; Social Ser- 
vice in hospitals, 228-230; new 
lines of, 225-228; Society of 
training school superinten- 
dents founded, 127; Spanish- 
American war nurses organise, 
204; state registration first un- 
dertaken, 142-144; work for, 
in Cab, IS9; Cob, 160; Conn., 
161; D. 6i C, 1O2; Del., 175; 
Ga., 169; lib, 167; Ind., 158; 
la., 166; Md., 157; Mass., 182; 
Mich., I'^o; Minn., 166; Mo., 
179; Neb., 173; N. J., 154; 
N.H., 165; N.Y., 151; N. C, 
153; Okla., 172; Ore., 184; 
Penn., 175; Tenn., 185; Tex., 
174; V't., 185; Va., 156; Wash., 
172; W. Va., 163; ^Vis., 185: 
Wyo., 171; statistics of train- 
ing schools. U. S. Bureau, 
1909,141; St. Margaret, Sisters 
of, 190-192; St. Vincent, «'-"is- 
ters of, 187-188; superinten- 
dents in Cuban war, 204; 
undergraduate private duty, 
136; visiting nursing for in- 
surance company, 224-225; 
visiting nursing, growth of, 
234; Wald, Lillian D., work 
begun, 215; story of, 216-220; 
war ser\-ice, 201-21 1; Welch, 
Dr. Wm., on registration, 158 

Visiting nursing, 

See name of 

Zomak, Sister Marie. See Spain 



; 1)C- 
s or- 


; new 
:y <>{ 
t un- 
: for, 


, 182; 


I. C, 



, Fis- 

)r in- 
h of. 
1, 158 


ne of